Provider Demographics
NPI:1760964696
Name:WHIPPLE, MAX DUANE III (SUDP, AAC)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:DUANE
Last Name:WHIPPLE
Suffix:III
Gender:M
Credentials:SUDP, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N STATE ST STE 522
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5045
Mailing Address - Country:US
Mailing Address - Phone:360-676-4485
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST STE 522
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5045
Practice Address - Country:US
Practice Address - Phone:360-676-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61158216101YM0800X
WA101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2238136Medicaid
WACO60880131OtherWASHINGTON DEPARTMENT OF HEALTH