Provider Demographics
NPI:1093844326
Name:WHITAKER, BEVERY RATLIFF (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERY
Middle Name:RATLIFF
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 SCENICVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1441
Mailing Address - Country:US
Mailing Address - Phone:859-223-1141
Mailing Address - Fax:859-223-0421
Practice Address - Street 1:704 SPRING MEADOWS DR # A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3624
Practice Address - Country:US
Practice Address - Phone:859-277-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1170103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist