Basic Information
| Provider Information | |||||||||
| NPI: | 1598112179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITAKER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A.;LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35555 KENAI SPUR HWY # 458 | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075457059 | ||||||||
| FaxNumber: | 9072604063 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 N BINKLEY ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077144521 | ||||||||
| FaxNumber: | 9072604063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2016 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 106271 | AK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.