Provider Demographics
NPI:1114227121
Name:WHITLEY, JOSEPHINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:508 DEEP EDDY AVE.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4555
Mailing Address - Country:US
Mailing Address - Phone:512-469-0765
Mailing Address - Fax:512-469-0889
Practice Address - Street 1:508 DEEP EDDY AVE.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4555
Practice Address - Country:US
Practice Address - Phone:512-469-0765
Practice Address - Fax:512-469-0889
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3425103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling