Provider Demographics
NPI:1154614618
Name:WHITELY, RUTH (PHD, LPC-S, NCC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:WHITELY
Suffix:
Gender:F
Credentials:PHD, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0377
Mailing Address - Country:US
Mailing Address - Phone:903-274-4140
Mailing Address - Fax:877-310-9115
Practice Address - Street 1:301 INTERSTATE HIGHWAY 30 STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-4512
Practice Address - Country:US
Practice Address - Phone:903-274-4140
Practice Address - Fax:877-310-9115
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62293101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2808701-01Medicaid