Basic Information
| Provider Information | |||||||||
| NPI: | 1124115647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9091 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863139091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287766054 | ||||||||
| FaxNumber: | 9287766176 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 N HWY 89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
| FaxNumber: | 9287766176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TB0200X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TE1100X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | 103TF0000X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Family | 103TF0200X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103TH0100X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103TP2701X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TR0400X | 3088 | AZ | X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
No ID Information.