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General NPI Number Information
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NPI Number | 1689852709
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Entity Type | Individual
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Provider Name | BRIAN KEITH WHITLOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 601 W 2ND ST SUITE 10
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City | ROSWELL
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State | NM
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Zip | 88201-4670
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Country | US
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Telephone | 575-623-9322
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Fax | 575-627-6339
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Provider Business Mailing Address
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Address Line | 601 W 2ND ST SUITE 10
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City | ROSWELL
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State | NM
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Zip | 88201-4670
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Country | US
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Telephone | 575-623-9322
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Fax | 575-627-6339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 0966
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0966
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License Number State | NM
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