Provider Demographics
NPI:1710111273
Name:GIPSON, WHITNEY (MSW, LMFT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:GIPSON
Suffix:
Gender:F
Credentials:MSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S HI LUSI AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3024
Mailing Address - Country:US
Mailing Address - Phone:847-322-0756
Mailing Address - Fax:
Practice Address - Street 1:500 W CENTRAL RD STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2381
Practice Address - Country:US
Practice Address - Phone:800-922-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150008210104100000X
IL166.000740106H00000X
MI4101006322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker