Provider Demographics
NPI:1801181144
Name:WHITAKER, ELIZABETH A (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7004
Mailing Address - Country:US
Mailing Address - Phone:219-861-1141
Mailing Address - Fax:
Practice Address - Street 1:8733 W. 400 N.
Practice Address - Street 2:400 NORTH MEDICAL CENTER
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:614-774-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002132A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health