Active NPI
Richard R Whittlesey, PH.D.
- Clinical Psychologist
- Fort Collins, CO
National Provider Identifier
1063400851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY.0003103
- Practice address
- 4601 Corbett Dr
Fort Collins, CO 80528-9579 - Phone
- (970) 207-4800
- Fax
- (970) 207-4885
- NPI assigned
- Oct 6, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 00194 | IA | |
| Clinical Psychologist | 103TC0700X | 00072 | IA | |
| Clinical Psychologist | 103TC0700X | PSY.0003103 | CO | Primary |
Addresses
Primary practice location
4601 Corbett Dr
Fort Collins, CO 80528-9579
Mailing address
4601 Corbett Dr
Fort Collins, CO 80528-9579
Phone (970) 207-4800
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2008243 | Medicaid | IA | |
| IA01A1 | Other | JOHN DEERE HEALTH PLAN | |
| 42660 | Other | IA | WELLMARK HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00194 | IA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460505600000",
"number": "1063400851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 CORBETT DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805289579",
"telephone_number": "970-207-4800",
"fax_number": "970-207-4885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 CORBETT DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805289579",
"telephone_number": "970-207-4800",
"fax_number": "970-207-4885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITTLESEY",
"first_name": "RICHARD",
"middle_name": "R",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-06",
"last_updated": "2016-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "00194",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "00072",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "PSY.0003103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2008243",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH PLAN",
"identifier": "IA01A1",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK HEALTH PLAN",
"identifier": "42660",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.