Provider Demographics
NPI:1104260959
Name:WHITEHOUSE, SHAYNA BRODY (PHD)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:BRODY
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 MAIN ST
Mailing Address - Street 2:370
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1867
Mailing Address - Country:US
Mailing Address - Phone:720-432-1336
Mailing Address - Fax:
Practice Address - Street 1:908 MAIN ST
Practice Address - Street 2:370
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1867
Practice Address - Country:US
Practice Address - Phone:720-432-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO013219103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool