Provider Demographics
NPI:1972204402
Name:WHITTAKER, KRISSIKA FAITH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISSIKA
Middle Name:FAITH
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISSIKA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1303 SE LYNN LN
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-6845
Mailing Address - Country:US
Mailing Address - Phone:580-286-7025
Mailing Address - Fax:580-286-7436
Practice Address - Street 1:1303 SE LYNN LN
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6845
Practice Address - Country:US
Practice Address - Phone:580-286-7025
Practice Address - Fax:580-286-7436
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health