Provider Demographics
NPI:1407031966
Name:WHALEN, ALICE MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MARIE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WILSON ST
Mailing Address - Street 2:P.O. BOX 94
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-1053
Mailing Address - Country:US
Mailing Address - Phone:812-384-1000
Mailing Address - Fax:812-384-3030
Practice Address - Street 1:331 WILSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1053
Practice Address - Country:US
Practice Address - Phone:812-384-1000
Practice Address - Fax:812-384-3030
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001057A101YM0800X
IN33002908A104100000X
IN35001189A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist