Provider Demographics
NPI:1013808930
Name:WHITEHEAD, MICHAEL BRIAN (MSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRIAN
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0004
Mailing Address - Country:US
Mailing Address - Phone:541-288-4499
Mailing Address - Fax:
Practice Address - Street 1:1750 12TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9540
Practice Address - Country:US
Practice Address - Phone:541-386-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical