Provider Demographics
NPI:1386844637
Name:WHITTLE, COURTNEY (MD MSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:MD MSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:NICOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MSW
Mailing Address - Street 1:15446 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4319
Mailing Address - Country:US
Mailing Address - Phone:310-217-5375
Mailing Address - Fax:
Practice Address - Street 1:15446 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4319
Practice Address - Country:US
Practice Address - Phone:310-217-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CAA129878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical