Provider Demographics
NPI:1568521722
Name:WHITLEY, RUTH H (LPC,LMFT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:H
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7785
Mailing Address - Country:US
Mailing Address - Phone:601-842-7449
Mailing Address - Fax:601-420-9252
Practice Address - Street 1:5611 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8929
Practice Address - Country:US
Practice Address - Phone:601-939-6634
Practice Address - Fax:601-420-9252
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0409101YP2500X
MSTO225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist