Provider Demographics
NPI:1386736197
Name:WHISENHUNT, GINA LYNN (LBP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LYNN
Last Name:WHISENHUNT
Suffix:
Gender:F
Credentials:LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WHISENHUNT DR
Mailing Address - Street 2:
Mailing Address - City:GILLHAM
Mailing Address - State:AR
Mailing Address - Zip Code:71841-9323
Mailing Address - Country:US
Mailing Address - Phone:870-584-6991
Mailing Address - Fax:
Practice Address - Street 1:17 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-4625
Practice Address - Country:US
Practice Address - Phone:580-286-5184
Practice Address - Fax:580-286-5185
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health