Provider Demographics
NPI:1205478443
Name:WHALEN, JAMES LEWIS (LMSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEWIS
Last Name:WHALEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 EDGEMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4201
Mailing Address - Country:US
Mailing Address - Phone:269-501-3360
Mailing Address - Fax:
Practice Address - Street 1:129 EDGEMOOR AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4201
Practice Address - Country:US
Practice Address - Phone:269-501-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010892891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical