Provider Demographics
NPI:1760964696
Name:WHIPPLE-, MAX DUANE III (MHT3, AAC)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:DUANE
Last Name:WHIPPLE-
Suffix:III
Gender:M
Credentials:MHT3, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N STATE ST STE 522
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5045
Mailing Address - Country:US
Mailing Address - Phone:360-676-4485
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST STE 522
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5045
Practice Address - Country:US
Practice Address - Phone:360-676-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60880131OtherWASHINGTON DEPARTMENT OF HEALTH