Basic Information
| Provider Information | |||||||||
| NPI: | 1578105532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITEWATER COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13075 STATE ROAD 1 | ||||||||
| Address2: | |||||||||
| City: | BROOKVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470128702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655754232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 440 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BROOKVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470121406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655754232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2019 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | STRIEGLER | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7655754232 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.