Provider Demographics
NPI:1710615927
Name:WHITNEY MEDIATIONS, LLC
Entity Type:Organization
Organization Name:WHITNEY MEDIATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LPC
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:985-870-2291
Mailing Address - Street 1:144 VALHI LAGOON XING
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3208
Mailing Address - Country:US
Mailing Address - Phone:985-870-2291
Mailing Address - Fax:985-236-4142
Practice Address - Street 1:144 VALHI LAGOON XING
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3208
Practice Address - Country:US
Practice Address - Phone:985-870-2291
Practice Address - Fax:985-236-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty