Provider Demographics
NPI:1679107270
Name:WHITLEY, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 DEPOT SQ
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1856
Mailing Address - Country:US
Mailing Address - Phone:740-550-1246
Mailing Address - Fax:
Practice Address - Street 1:103 CARRICO DR
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-3006
Practice Address - Country:US
Practice Address - Phone:740-307-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor