Healthcare Provider Details

I. General information

NPI: 1750446878
Provider Name (Legal Business Name): GARY SCOTT WHITING PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 WURZBACH RD SUITE V-104
SAN ANTONIO TX
78240-1303
US

IV. Provider business mailing address

50 OLD SAN ANTONIO RD
BOERNE TX
78006-3412
US

V. Phone/Fax

Practice location:
  • Phone: 210-697-3300
  • Fax: 210-424-0106
Mailing address:
  • Phone: 830-331-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2-4700
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: