Provider Demographics
NPI:1548696081
Name:WHITTINGTON, CHARLES OTIS III (MA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:OTIS
Last Name:WHITTINGTON
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 WASHINGTON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2609
Mailing Address - Country:US
Mailing Address - Phone:816-200-2262
Mailing Address - Fax:
Practice Address - Street 1:4010 WASHINGTON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2609
Practice Address - Country:US
Practice Address - Phone:816-200-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional