Provider Demographics
NPI:1912034166
Name:WHITTY, SHAWN ALEXANDER (NCSP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ALEXANDER
Last Name:WHITTY
Suffix:
Gender:M
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MAIN ST
Mailing Address - Street 2:SUITE 249
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1206
Mailing Address - Country:US
Mailing Address - Phone:505-527-5823
Mailing Address - Fax:505-527-5886
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:SUITE 249
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1206
Practice Address - Country:US
Practice Address - Phone:505-527-5823
Practice Address - Fax:505-527-5886
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool