Provider Demographics
NPI:1063157246
Name:HOLIDAY WHISENANT COUNSELING LLC
Entity type:Organization
Organization Name:HOLIDAY WHISENANT COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLIDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHISENANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-287-3574
Mailing Address - Street 1:1253 HOLLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2529
Mailing Address - Country:US
Mailing Address - Phone:850-220-8339
Mailing Address - Fax:
Practice Address - Street 1:1253 HOLLIDAY DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2529
Practice Address - Country:US
Practice Address - Phone:850-220-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009555800Medicaid