Provider Demographics
NPI:1477731099
Name:WHITBY, MISTY ANN (LISW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:WHITBY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 SCENIC DR
Mailing Address - Street 2:GERALD CHAMPION REGIONAL MEDICAL CENTER
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8700
Mailing Address - Country:US
Mailing Address - Phone:575-446-5321
Mailing Address - Fax:575-446-5319
Practice Address - Street 1:2669 SCENIC DR
Practice Address - Street 2:GERALD CHAMPION REGIONAL MEDICAL CENTER
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8700
Practice Address - Country:US
Practice Address - Phone:575-446-5321
Practice Address - Fax:575-446-5319
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-076461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical