Active NPI
Jantzen Wayne Whitehead, MS
- Mental Health Counselor
- Marianna, FL
National Provider Identifier
1831430826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH10814
- Practice address
- 2860 Highway 71 N
Suite a
Marianna, FL 32446 - Phone
- (850) 482-0019
- Fax
- (850) 482-0015
- NPI assigned
- Mar 15, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH10814 | FL | Primary |
Addresses
Primary practice location
2860 Highway 71 N
Suite a
Marianna, FL 32446
Mailing address
5601 Highway 231
Campbellton, FL 32426
Phone (850) 693-9752
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH10814 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson-Calhoun Counseling Services, Inc | 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.
-
- Community/Behavioral Health Agency
- Marianna, FL
- NPI 1871924787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363305600000",
"number": "1831430826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5601 HIGHWAY 231",
"city": "CAMPBELLTON",
"state": "FL",
"postal_code": "32426",
"telephone_number": "850-693-9752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2860 HIGHWAY 71 N",
"address_2": "SUITE A",
"city": "MARIANNA",
"state": "FL",
"postal_code": "32446",
"telephone_number": "850-482-0019",
"fax_number": "850-482-0015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "JANTZEN",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-15",
"last_updated": "2013-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH10814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marianna, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.