Provider Demographics
NPI:1942359484
Name:WHELTON JR, JOHN P, (PHD,MP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P,
Last Name:WHELTON JR
Suffix:
Gender:M
Credentials:PHD,MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 BUFFALO HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7313
Mailing Address - Country:US
Mailing Address - Phone:225-654-5060
Mailing Address - Fax:
Practice Address - Street 1:1237 BUFFALO HOLLOW CT
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7313
Practice Address - Country:US
Practice Address - Phone:225-654-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300MP103TC0700X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)