Provider Demographics
NPI:1881037661
Name:WHITLEY, MARNIE (NMD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:NMD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 W PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4412 W PIEDMONT RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2095
Practice Address - Country:US
Practice Address - Phone:480-363-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 12941101Y00000X
AZ13-1356175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No101Y00000XBehavioral Health & Social Service ProvidersCounselor