Provider Demographics
NPI:1346871035
Name:WHITTEN, EUGENE K (LMHCA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:K
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 GALEN DR W STE 109
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8659
Mailing Address - Country:US
Mailing Address - Phone:317-421-7626
Mailing Address - Fax:317-421-7626
Practice Address - Street 1:7114 GALEN DR W STE 109
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8659
Practice Address - Country:US
Practice Address - Phone:317-421-7626
Practice Address - Fax:317-421-7626
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001130A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health