Provider Demographics
NPI:1467581397
Name:WHITLEY, RICHARD G
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:1802
Mailing Address - City:CENTURY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-9500
Mailing Address - Fax:310-553-7247
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:1802
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-9500
Practice Address - Fax:310-553-7247
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW0412181749101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)