Provider Demographics
NPI:1962436493
Name:WHITETREE, VICTORIA (LSCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WHITETREE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:STREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 N TYLER RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3713
Mailing Address - Country:US
Mailing Address - Phone:316-869-2220
Mailing Address - Fax:316-869-2221
Practice Address - Street 1:123 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3713
Practice Address - Country:US
Practice Address - Phone:316-869-2220
Practice Address - Fax:316-869-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical