Active NPI
Jimmie C. Whitley, ED.D.
- Clinical Psychologist
- Houston, TX
National Provider Identifier
1376605998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- TX2-1974
- Practice address
- 1125 Cypress Station Dr
Building B-1
Houston, TX 77090-3054 - Phone
- (281) 537-7207
- Fax
- (281) 580-5061
- NPI assigned
- Dec 14, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | TX2-1974 | TX | Primary |
Addresses
Primary practice location
1125 Cypress Station Dr
Building B-1
Houston, TX 77090-3054
Mailing address
1125 Cypress Station Dr
Building B-1
Houston, TX 77090-3054
Phone (281) 537-7207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115635801 | Medicaid | TX |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TX2-1974 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238457600000",
"number": "1376605998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 CYPRESS STATION DR",
"address_2": "BUILDING B-1",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770903054",
"telephone_number": "281-537-7207",
"fax_number": "281-580-5061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 CYPRESS STATION DR",
"address_2": "BUILDING B-1",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770903054",
"telephone_number": "281-537-7207",
"fax_number": "281-580-5061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITLEY",
"first_name": "JIMMIE",
"middle_name": "C.",
"name_prefix": "Mr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2009-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "TX2-1974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "115635801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.