Provider Demographics
NPI:1114619905
Name:LOFTIN, WHITLEY
Entity Type:Individual
Prefix:
First Name:WHITLEY
Middle Name:
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ARRINGTON RD APT 1122
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-2827
Mailing Address - Country:US
Mailing Address - Phone:832-646-9818
Mailing Address - Fax:
Practice Address - Street 1:1650 ARRINGTON RD APT 1122
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-2827
Practice Address - Country:US
Practice Address - Phone:832-646-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician