Active NPI
Joel Tyler Whiteside, LPC
- Professional Counselor
- Avondale, AZ
National Provider Identifier
1548039100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-22756
- Practice address
- 10756 W Buchanan St
Avondale, AZ 85323-5441 - Phone
- (360) 703-7138
- NPI assigned
- Dec 25, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-22756 | AZ | Primary |
| Mental Health Counselor | 101YM0800X | 22756 | AZ |
Addresses
Primary practice location
10756 W Buchanan St
Avondale, AZ 85323-5441
Mailing address
10756 W Buchanan St
Avondale, AZ 85323-5441
Phone (360) 703-7138
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22756 | AZ | MD | Mental Health Counselor |
| LPC-22756 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708473600000",
"number": "1548039100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10756 W BUCHANAN ST",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853235441",
"telephone_number": "360-703-7138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10756 W BUCHANAN ST",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853235441",
"telephone_number": "360-703-7138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITESIDE",
"first_name": "JOEL",
"middle_name": "TYLER",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-12-25",
"last_updated": "2024-02-21",
"certification_date": "2024-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-22756",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "22756",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.