Provider Demographics
NPI:1881904407
Name:LABEAU, WHITNEY
Entity type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:
Last Name:LABEAU
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 1:10278 BLACK MOUNTAIN RD
Mailing Address - Street 2:173
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3872
Mailing Address - Country:US
Mailing Address - Phone:734-755-8956
Mailing Address - Fax:
Practice Address - Street 1:10278 BLACK MOUNTAIN RD
Practice Address - Street 2:173
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-3872
Practice Address - Country:US
Practice Address - Phone:734-755-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA26-3162747103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst