Provider Demographics
NPI:1922234566
Name:WHITEMAN, FELICIA ANN (PHD, MP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ANN
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:ANN
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MP
Mailing Address - Street 1:2331 CAREY ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3627
Mailing Address - Country:US
Mailing Address - Phone:985-646-6406
Mailing Address - Fax:985-646-6460
Practice Address - Street 1:2331 CAREY ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3627
Practice Address - Country:US
Practice Address - Phone:985-646-6406
Practice Address - Fax:985-646-6460
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.0007103TP0016X
LAMPAP.00044103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2356020Medicaid