Provider Demographics
NPI:1437376308
Name:WHITEHOUSE, ROBERT P (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:WHITEHOUSE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:190 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2641
Mailing Address - Country:US
Mailing Address - Phone:303-417-0293
Mailing Address - Fax:303-666-7160
Practice Address - Street 1:5485 CONESTOGA CT
Practice Address - Street 2:SUITE 100-D
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2752
Practice Address - Country:US
Practice Address - Phone:303-417-0293
Practice Address - Fax:303-666-7160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO148127800OtherOWCP FECA
CO07019557Medicaid
CO148127800OtherOWCP FECA
CO07019557Medicaid
CO$$$$$$$$$OtherANTHEM BLUE CROSS BLUE SHIELD