Provider Demographics
NPI:1750446878
Name:WHITING, GARY SCOTT (PHD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:SCOTT
Last Name:WHITING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OLD SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3412
Mailing Address - Country:US
Mailing Address - Phone:830-331-1267
Mailing Address - Fax:
Practice Address - Street 1:8607 WURZBACH RD
Practice Address - Street 2:SUITE V-104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1303
Practice Address - Country:US
Practice Address - Phone:210-697-3300
Practice Address - Fax:210-424-0106
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4700103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0343279-01Medicaid