Healthcare Provider Details

I. General information

NPI: 1982042180
Provider Name (Legal Business Name): WESLEY SCOTT WHITACRE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 N MAIN ST
DECATUR AR
72722-9732
US

IV. Provider business mailing address

7000 H C KELLEY RD
ORLANDO FL
32831-2518
US

V. Phone/Fax

Practice location:
  • Phone: 479-752-3233
  • Fax: 479-752-3235
Mailing address:
  • Phone: 407-207-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number202447
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: