Provider Demographics
NPI:1942442611
Name:WHITLEY, BRIAN TAYLOR
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TAYLOR
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 DOVE ST STE 180
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2816
Mailing Address - Country:US
Mailing Address - Phone:949-933-5872
Mailing Address - Fax:
Practice Address - Street 1:1001 DOVE ST STE 180
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2816
Practice Address - Country:US
Practice Address - Phone:949-933-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist