Provider Demographics
NPI:1255902102
Name:BRIAN WHITLEY, MARRIAGE AND FAMILY THERAPIST, INC.
Entity type:Organization
Organization Name:BRIAN WHITLEY, MARRIAGE AND FAMILY THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-933-5872
Mailing Address - Street 1:1001 DOVE ST STE 180
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2816
Mailing Address - Country:US
Mailing Address - Phone:949-933-5872
Mailing Address - Fax:
Practice Address - Street 1:1001 DOVE ST STE 180
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2816
Practice Address - Country:US
Practice Address - Phone:949-933-5872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health