Provider Demographics
NPI:1982042180
Name:WHITACRE, WESLEY SCOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:SCOTT
Last Name:WHITACRE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 H C KELLEY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32831-2518
Mailing Address - Country:US
Mailing Address - Phone:407-207-7777
Mailing Address - Fax:
Practice Address - Street 1:7000 H C KELLEY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32831-2518
Practice Address - Country:US
Practice Address - Phone:407-207-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 0003526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist