Provider Demographics
NPI:1841254877
Name:WHITTEN, RAYMOND D (LPC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:D
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-3912
Mailing Address - Country:US
Mailing Address - Phone:903-794-0354
Mailing Address - Fax:903-794-0354
Practice Address - Street 1:1920 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-3912
Practice Address - Country:US
Practice Address - Phone:903-794-0354
Practice Address - Fax:903-794-0354
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16186101YP2500X
ARP9712027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
148140OtherVALUEOPTIONS
AR6178LCOtherCORPHEALTH ARKANSAS
AR5U612OtherBLUE CROSS BLUE SHIELD
AR84493LOtherBLUE CROSS BLUE SHIELD