Provider Demographics
NPI:1437602786
Name:WHITING, NATHAN (MA, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:WHITING
Suffix:
Gender:M
Credentials:MA, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:405 E. LASALLE AVE.
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-0142
Mailing Address - Country:US
Mailing Address - Phone:715-296-3840
Mailing Address - Fax:715-637-5749
Practice Address - Street 1:405 E. LASALLE AVE.
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812
Practice Address - Country:US
Practice Address - Phone:715-296-3840
Practice Address - Fax:715-637-5749
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15915-132101YA0400X
WI6013125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437602786Medicaid