Provider Demographics
NPI:1962855833
Name:WHIPPLE, ANDREA MAREN (LCPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAREN
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N WOOD RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-6290
Mailing Address - Country:US
Mailing Address - Phone:618-213-3046
Mailing Address - Fax:618-213-3046
Practice Address - Street 1:1400 N WOOD RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-6290
Practice Address - Country:US
Practice Address - Phone:618-213-3046
Practice Address - Fax:618-213-3046
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health