Provider Demographics
NPI:1316452691
Name:STATHAM, WHITNEY JEAN (PHD, LP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JEAN
Last Name:STATHAM
Suffix:
Gender:
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 S PENNSYLVANIA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6937
Mailing Address - Country:US
Mailing Address - Phone:405-257-0172
Mailing Address - Fax:405-548-1444
Practice Address - Street 1:9220 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6937
Practice Address - Country:US
Practice Address - Phone:405-257-0172
Practice Address - Fax:405-548-1444
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088270103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling