Provider Demographics
NPI:1669457149
Name:WHITEHEAD, WILLIAM CLAUDE (PH D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLAUDE
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 VILLAGE CREEK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4437
Mailing Address - Country:US
Mailing Address - Phone:972-818-3993
Mailing Address - Fax:972-250-3644
Practice Address - Street 1:5232 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4437
Practice Address - Country:US
Practice Address - Phone:972-818-3993
Practice Address - Fax:972-250-3644
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G84CMedicare ID - Type Unspecified