Provider Demographics
NPI:1821899253
Name:WHITAKER, COURTNEY (LMSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7480
Mailing Address - Country:US
Mailing Address - Phone:417-848-8068
Mailing Address - Fax:
Practice Address - Street 1:4235 S CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4370
Practice Address - Country:US
Practice Address - Phone:417-501-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250060281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical