Provider Demographics
NPI:1467631218
Name:BRUCE L. WHITNEY, PH.D., A PSCYHOLOGY CORPORATION
Entity Type:Organization
Organization Name:BRUCE L. WHITNEY, PH.D., A PSCYHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-857-1289
Mailing Address - Street 1:2239 TOWNSGATE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2429
Mailing Address - Country:US
Mailing Address - Phone:805-496-2343
Mailing Address - Fax:805-214-3552
Practice Address - Street 1:2393 TOWNSGATE RD STE 100A
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2513
Practice Address - Country:US
Practice Address - Phone:805-496-2343
Practice Address - Fax:805-214-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17146Medicaid