Provider Demographics
NPI:1831736032
Name:WHITEMAN, PHILLENE (LAC)
Entity type:Individual
Prefix:MS
First Name:PHILLENE
Middle Name:
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2303
Mailing Address - Country:US
Mailing Address - Phone:406-534-4558
Mailing Address - Fax:406-290-7450
Practice Address - Street 1:1230 N 30TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0128
Practice Address - Country:US
Practice Address - Phone:406-534-4558
Practice Address - Fax:406-290-7450
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBHLACLIC32706101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)