Provider Demographics
NPI:1760765911
Name:WHITEHEAD BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:WHITEHEAD BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:956-244-1747
Mailing Address - Street 1:1144 FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-1781
Mailing Address - Country:US
Mailing Address - Phone:956-244-1747
Mailing Address - Fax:
Practice Address - Street 1:722 MORGAN BLVD
Practice Address - Street 2:SUITE V
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5139
Practice Address - Country:US
Practice Address - Phone:956-244-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty