Provider Demographics
NPI:1609412154
Name:WHITEHOUSE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:WHITEHOUSE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WHITEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-315-7208
Mailing Address - Street 1:PO BOX 22618
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-2618
Mailing Address - Country:US
Mailing Address - Phone:270-574-5600
Mailing Address - Fax:270-574-5609
Practice Address - Street 1:920 FREDERICA ST STE 204
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3077
Practice Address - Country:US
Practice Address - Phone:270-574-5600
Practice Address - Fax:270-574-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2016019876OtherANCC
KY3010792OtherNURSING LICENSE