Whitehead, Russell Roy
Whitehead, Russell Roy is an individual health care provider with primary practice located at 909 E State Blvd , Fort Wayne IN 46805-3404. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Whitehead, Russell Roy can be contacted via phone (260) 481-2700.Contact Information
Primary practice address
909 E State Blvd
Fort Wayne IN 46805-3404
Phone: (260) 481-2700
Fax: (260) 481-2717
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 34001909A | Indiana |
Profile Details
| NPI number | 1801844659 |
|---|---|
| LBN Legal business name | Whitehead, Russell Roy |
| Credentials | MSW, LCSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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