Provider Demographics
NPI:1790764389
Name:WHITNEY, BRUCE LEE (PHD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:LEE
Last Name:WHITNEY
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 1:2239 TOWNSGATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2405
Mailing Address - Country:US
Mailing Address - Phone:805-493-0325
Mailing Address - Fax:805-241-3552
Practice Address - Street 1:2239 TOWNSGATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2405
Practice Address - Country:US
Practice Address - Phone:805-493-0325
Practice Address - Fax:805-241-3552
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14884103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY14884OtherSTATE LICENSE
CAW17146Medicare ID - Type UnspecifiedCA MEDICARE GROUP NUMBER
CAWCP14884AMedicare ID - Type UnspecifiedIND. MEDICARE IN GROUP