Provider Demographics
NPI:1417087362
Name:WHITEHEAD, BRIAN HOWARD
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HOWARD
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 REVILO RD
Mailing Address - Street 2:
Mailing Address - City:LEOMA
Mailing Address - State:TN
Mailing Address - Zip Code:38468-5543
Mailing Address - Country:US
Mailing Address - Phone:931-852-2237
Mailing Address - Fax:
Practice Address - Street 1:6011-A TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-560-3061
Practice Address - Fax:931-560-3062
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional