Provider Demographics
NPI:1740601475
Name:WHALEY, BRAD (LMSW)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:WHALEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 SW SENA DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1754
Mailing Address - Country:US
Mailing Address - Phone:785-249-8813
Mailing Address - Fax:
Practice Address - Street 1:3715 SW SENA DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1754
Practice Address - Country:US
Practice Address - Phone:785-249-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6213320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness