Provider Demographics
NPI:1801002084
Name:WHITEHILL, MARK BENNETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENNETT
Last Name:WHITEHILL
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 1:3815 100TH ST SW
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4401
Mailing Address - Country:US
Mailing Address - Phone:253-984-7686
Mailing Address - Fax:253-984-7862
Practice Address - Street 1:3815 100TH ST SW
Practice Address - Street 2:SUITE 2-B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4401
Practice Address - Country:US
Practice Address - Phone:253-984-7686
Practice Address - Fax:253-984-7862
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001200103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical