Provider Demographics
NPI:1356135156
Name:WHITLEY, SERENA M
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:M
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6827
Mailing Address - Country:US
Mailing Address - Phone:360-913-2460
Mailing Address - Fax:
Practice Address - Street 1:410 W BAKERVIEW RD STE 110
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8194
Practice Address - Country:US
Practice Address - Phone:360-524-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician