Healthcare Provider Details

I. General information

NPI: 1154785665
Provider Name (Legal Business Name): MELANIE WHETSTINE PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 E MAIN ST SUITE 226
PULLMAN WA
99163-2678
US

IV. Provider business mailing address

254 E MAIN ST SUITE 226
PULLMAN WA
99163-2678
US

V. Phone/Fax

Practice location:
  • Phone: 509-330-5456
  • Fax: 509-561-6229
Mailing address:
  • Phone: 509-330-5456
  • Fax: 509-561-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60484398
License Number StateWA

VIII. Authorized Official

Name: DR. MELANIE L WHETSTINE
Title or Position: LICENSED PSYCHOLOGIST/OWNER
Credential: PHD
Phone: 509-330-5456