Provider Demographics
NPI:1073869244
Name:BOOLE, WHITNEY (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:BOOLE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:BOOLE WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:934 HERMOSA AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4122
Mailing Address - Country:US
Mailing Address - Phone:310-989-6465
Mailing Address - Fax:
Practice Address - Street 1:934 HERMOSA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4122
Practice Address - Country:US
Practice Address - Phone:310-989-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 66982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist