Healthcare Provider Details

I. General information

NPI: 1437720117
Provider Name (Legal Business Name): WESLEY TAM WHITTLESEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

IV. Provider business mailing address

1654 LANDQUIST DR
ENCINITAS CA
92024-4755
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: