Provider Demographics
NPI:1437217098
Name:WHITAKER, ROBERT LEE (PHD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 SCENIC VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-7133
Mailing Address - Country:US
Mailing Address - Phone:865-384-7009
Mailing Address - Fax:865-690-0720
Practice Address - Street 1:8870 CEDAR SPRINGS LN # 209
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5407
Practice Address - Country:US
Practice Address - Phone:865-690-0510
Practice Address - Fax:865-690-0720
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1967103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3686229Medicare ID - Type UnspecifiedMEDICARE NUMBER
TNG81913Medicare UPIN