Basic Information
| Provider Information | |||||||||
| NPI: | 1558532432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHELAN | ||||||||
| OtherFirstName: | JAMES | ||||||||
| OtherMiddleName: | JOSEPH | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | JR. | ||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169858610 | ||||||||
| FaxNumber: | 9162943122 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169858610 | ||||||||
| FaxNumber: | 9162943122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY8378 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.