Provider Demographics
NPI:1003442310
Name:WHITTAKER, GARY (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 TAUTOG CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315
Mailing Address - Country:US
Mailing Address - Phone:360-315-3072
Mailing Address - Fax:360-315-3058
Practice Address - Street 1:1099 TAUTOG CIRCLE
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-1012
Practice Address - Country:US
Practice Address - Phone:360-315-3072
Practice Address - Fax:360-315-3058
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF1082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist