Individual
DR. ALWYN S. WHITEHEAD JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
6920 BANCROFT AVE, SAINT LOUIS, MO 63109-1902
(417) 234-1670
Mailing address
6920 BANCROFT AVE, SAINT LOUIS, MO 63109-1902
(417) 234-1670
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2002011127
MO
103TC0700X
Clinical Psychologist
Primary
2002011127
MO
103TF0200X
Forensic Psychologist
2002011127
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43-1804357
TAX ID
MO
Enumeration date
05/10/2007
Last updated
04/22/2020
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