Provider Demographics
NPI:1871868067
Name:WHIPPLE, CARON DEBORAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARON
Middle Name:DEBORAH
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARON
Other - Middle Name:DEBORAH
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 REGATTA DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6891
Mailing Address - Country:US
Mailing Address - Phone:702-822-6675
Mailing Address - Fax:702-998-0395
Practice Address - Street 1:2620 REGATTA DR
Practice Address - Street 2:SUITE 212
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6891
Practice Address - Country:US
Practice Address - Phone:702-822-6675
Practice Address - Fax:702-998-0395
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPYO294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical