Provider Demographics
NPI:1881963254
Name:WHITING, SHANE A (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:A
Last Name:WHITING
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E 11400 S
Mailing Address - Street 2:#186
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6705
Mailing Address - Country:US
Mailing Address - Phone:435-709-7050
Mailing Address - Fax:801-904-0077
Practice Address - Street 1:3725 S BIG HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3978
Practice Address - Country:US
Practice Address - Phone:435-709-7050
Practice Address - Fax:801-904-0077
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5691843-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist