Provider Demographics
NPI:1902166788
Name:WHITEFIELD, JAMES MACK (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MACK
Last Name:WHITEFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:WHITEFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4413 SPICEWOOD SPRINGS RD STE 123
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8580
Mailing Address - Country:US
Mailing Address - Phone:512-965-7596
Mailing Address - Fax:512-505-2790
Practice Address - Street 1:4413 SPICEWOOD SPRINGS RD STE 123
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8580
Practice Address - Country:US
Practice Address - Phone:512-965-7596
Practice Address - Fax:512-505-2790
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25344103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist