Provider Demographics
NPI:1740371277
Name:WHITAKER, FELICIA HENSLEY (LPC)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:HENSLEY
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:HENSLEY-WHITAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M A, LPC
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-0300
Mailing Address - Country:US
Mailing Address - Phone:318-872-5023
Mailing Address - Fax:903-988-0243
Practice Address - Street 1:1915 MCARTHUR DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-4505
Practice Address - Country:US
Practice Address - Phone:318-872-1309
Practice Address - Fax:318-872-1337
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14951101YP2500X
LA4150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095959503Medicaid
TX83164LOtherBLUE CROSS BLUE SHIELD