Healthcare Provider Details

I. General information

NPI: 1154669398
Provider Name (Legal Business Name): EILEEN WHELAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EILEEN WRIGHT

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W VISALIA RD SUITE B
FARMERSVILLE CA
93223-1868
US

IV. Provider business mailing address

PO BOX 5091
VISALIA CA
93278-5091
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-0115
  • Fax: 559-747-0295
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: