Provider Demographics
NPI:1912484197
Name:WHITLOCK, DARREN
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:WHITLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 ANTELOPE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-7321
Mailing Address - Country:US
Mailing Address - Phone:775-297-2416
Mailing Address - Fax:
Practice Address - Street 1:9535 OAKLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6101
Practice Address - Country:US
Practice Address - Phone:775-843-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst