Provider Demographics
NPI:1851628945
Name:WHITTAKER, STEPHEN DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DAVID
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4057
Mailing Address - Country:US
Mailing Address - Phone:503-547-8686
Mailing Address - Fax:503-547-0505
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4057
Practice Address - Country:US
Practice Address - Phone:503-547-8686
Practice Address - Fax:503-547-0505
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10129935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional