Active NPI
Alan J. Whitlock, PH.D.
- Counseling Psychologist
- Moscow, ID
National Provider Identifier
1174533525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- PSY 340
- Practice address
- 814 S Washington St
Moscow, ID 83843-3049 - Phone
- (208) 883-4026
- NPI assigned
- Aug 8, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PSY 340 | ID | Primary |
Addresses
Primary practice location
814 S Washington St
Moscow, ID 83843-3049
Mailing address
814 S Washington St
Moscow, ID 83843-3049
Phone (208) 883-4026
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010017398 | Other | ID | REGENCE BLUE SHIELD OF ID |
| N3405 | Other | ID | BLUE CROSS OF IDAHO |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 340 | ID | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174533525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 S WASHINGTON ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838433049",
"telephone_number": "208-883-4026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "814 S WASHINGTON ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838433049",
"telephone_number": "208-883-4026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITLOCK",
"first_name": "ALAN",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "ID",
"license": "PSY 340",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010017398",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "N3405",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.