Provider Demographics
NPI:1073815056
Name:WHITTAKER, CHRISTINE JENNY (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JENNY
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:WHITTAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:14502 NORTH DALE MABRY HWY
Mailing Address - Street 2:SUITE#200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2746
Mailing Address - Country:US
Mailing Address - Phone:813-240-0855
Mailing Address - Fax:727-800-1854
Practice Address - Street 1:14502 NORTH DALE MABRY HWY
Practice Address - Street 2:SUITE#200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2746
Practice Address - Country:US
Practice Address - Phone:813-240-0855
Practice Address - Fax:727-800-1854
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3018251S00000X
FLMT3108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023910300Medicaid