Provider Demographics
NPI:1477244952
Name:WHITED, JUDITH DANIELLE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:DANIELLE
Last Name:WHITED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:DANIELLE
Other - Last Name:REGALADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5340 N TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6293
Mailing Address - Country:US
Mailing Address - Phone:682-900-1444
Mailing Address - Fax:432-322-4597
Practice Address - Street 1:5340 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6293
Practice Address - Country:US
Practice Address - Phone:682-900-1444
Practice Address - Fax:432-322-4597
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician