Provider Demographics
NPI:1689332058
Name:WHALEN, ANDREA SUE (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905C N COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1205
Mailing Address - Country:US
Mailing Address - Phone:816-865-1236
Mailing Address - Fax:
Practice Address - Street 1:905C N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1205
Practice Address - Country:US
Practice Address - Phone:816-865-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012007112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional