Provider Demographics
NPI:1558487504
Name:WHITNEY, TIMOTHY LANE (PSYD,)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LANE
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 WILSHIRE BLVD
Mailing Address - Street 2:PENTHOUSE 4
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5530
Mailing Address - Country:US
Mailing Address - Phone:310-246-1159
Mailing Address - Fax:323-845-4528
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:PENTHOUSE 4
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-246-1159
Practice Address - Fax:323-845-4528
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20401Medicare ID - Type UnspecifiedPSYCHOLOGIST