Provider Demographics
NPI:1104914027
Name:WHATLEY, PHILIP RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RICHARD
Last Name:WHATLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:WHATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6008 ABERFELDY CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8344
Mailing Address - Country:US
Mailing Address - Phone:614-226-6154
Mailing Address - Fax:
Practice Address - Street 1:597 EXECUTIVE CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8870
Practice Address - Country:US
Practice Address - Phone:614-356-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6222103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist