Phillip Whitely, CDCA, PRS

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

0001602 Issued in OH

Practice address

411 2ND St
Portsmouth, OH 45662-3806

Phone

(740) 354-7545

NPI assigned

Oct 31, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1316414089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 3RD ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623811",
            "telephone_number": "740-716-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 2ND ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623806",
            "telephone_number": "740-354-7545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "433 3rd St",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "OH",
            "postal_code": "456623811",
            "country_code": "US",
            "telephone_number": "740-354-7545 x354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITELY",
        "first_name": "PHILLIP",
        "credential": "CDCA, PRS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-31",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "0001602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devin Alexander Jordan White, LSW
• Jack D White, CDCA
• James White
• Kelli Mae White
• Mallory White, COTA/L
• Molly Jo Whitman, PTA
• Alexandria Leeann Whitt
• Kendall K Whitt
• Melvina Whitt
• Tarrah Wilburn

• Peer Specialist in Portsmouth, OH
• Providers in Portsmouth, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.