Basic Information
Provider Information | |||||||||
NPI: | 1053708750 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCWHORTER | ||||||||
FirstName: | RACEAL | ||||||||
MiddleName: | DENISE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.A. MFTI | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 56774 | ||||||||
Address2: |   | ||||||||
City: | SHERMAN OAKS | ||||||||
State: | CA | ||||||||
PostalCode: | 914131774 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7146790759 | ||||||||
FaxNumber: | 8189456816 | ||||||||
Practice Location | |||||||||
Address1: | 44447 10TH ST W | ||||||||
Address2: |   | ||||||||
City: | LANCASTER | ||||||||
State: | CA | ||||||||
PostalCode: | 935343324 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6617262630 | ||||||||
FaxNumber: | 6619403412 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2015 | ||||||||
LastUpdateDate: | 04/20/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | CERTIFICATION | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.