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Individual

JERRY L WHITEMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD.

Contact information

Practice address
2829 4TH AVE, 150, LAKE CHARLES, LA 70601-7887
(337) 477-7091
(337) 474-4552
Mailing address
2829 4TH AVE, 150, LAKE CHARLES, LA 70601-7887
(337) 477-7091
(337) 474-4552

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
407
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1125466
LA
Enumeration date
03/21/2006
Last updated
12/02/2010
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