Provider Demographics
NPI:1649520420
Name:WHITLEY, SHIRLEY REBEKAH (PLCP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:REBEKAH
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:PLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 1664
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65779-9706
Mailing Address - Country:US
Mailing Address - Phone:816-289-0472
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 1664
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:MO
Practice Address - Zip Code:65779-9706
Practice Address - Country:US
Practice Address - Phone:816-289-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012032149101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor