Provider Demographics
NPI:1083041461
Name:WHATLEY, CECILY GRASSO (LCDC)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:GRASSO
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 GOLF CREST DR
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1819
Mailing Address - Country:US
Mailing Address - Phone:409-457-0120
Mailing Address - Fax:
Practice Address - Street 1:6501 GOLF CREST DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1819
Practice Address - Country:US
Practice Address - Phone:409-457-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)