Provider Demographics
NPI:1154602266
Name:WHITTLER, ROGER DALE
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DALE
Last Name:WHITTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:WHITTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3482 GETTYSBURG PL
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6886
Mailing Address - Country:US
Mailing Address - Phone:573-645-5955
Mailing Address - Fax:
Practice Address - Street 1:312 W DUNKLIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1617
Practice Address - Country:US
Practice Address - Phone:573-645-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional