Provider Demographics
NPI:1295344166
Name:WHALER, BRANDY LEE (LADC-MH, LMSW/ MSW)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE
Last Name:WHALER
Suffix:
Gender:F
Credentials:LADC-MH, LMSW/ MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 E 583 RD
Mailing Address - Street 2:
Mailing Address - City:ROSE
Mailing Address - State:OK
Mailing Address - Zip Code:74364-1223
Mailing Address - Country:US
Mailing Address - Phone:918-506-7605
Mailing Address - Fax:
Practice Address - Street 1:282 S HWY 10
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:OK
Practice Address - Zip Code:74347
Practice Address - Country:US
Practice Address - Phone:918-868-8120
Practice Address - Fax:918-525-0013
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK1470101YA0400X
OK79661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty