Provider Demographics
NPI:1104331347
Name:WHITEHURST, JUDY ARLENE (LMSW)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ARLENE
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 WINTERS DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1635
Mailing Address - Country:US
Mailing Address - Phone:269-806-3786
Mailing Address - Fax:
Practice Address - Street 1:6938 ELM VALLEY DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7436
Practice Address - Country:US
Practice Address - Phone:269-552-4224
Practice Address - Fax:269-552-4216
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010872101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical