Active NPI
Danny Whitehead, LICSW
- Clinical Social Worker
- Devils Lake, ND
National Provider Identifier
1356552012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4370
- Practice address
- 211 4TH St NE
Ste 4
Devils Lake, ND 58301-2479 - Phone
- (701) 662-8255
- Fax
- (701) 662-1739
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4370 | ND | Primary |
Addresses
Primary practice location
211 4TH St NE
Ste 4
Devils Lake, ND 58301-2479
Mailing address
PO Box 883
Devils Lake, ND 58301-0883
Phone (701) 662-8255
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19260 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blooming Prairie Assessment & Therapy Center P.C. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Devils Lake, ND
- NPI 1649461344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254441600000",
"number": "1356552012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 883",
"city": "DEVILS LAKE",
"state": "ND",
"postal_code": "583010883",
"telephone_number": "701-662-8255",
"fax_number": "701-662-1739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 4TH ST NE",
"address_2": "STE 4",
"city": "DEVILS LAKE",
"state": "ND",
"postal_code": "583012479",
"telephone_number": "701-662-8255",
"fax_number": "701-662-1739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "DANNY",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2009-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ND",
"license": "4370",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "19260",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Devils Lake, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.