Basic Information
| Provider Information | |||||||||
| NPI: | 1417063298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | THERESA | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2508 WILSON ST | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062341687 | ||||||||
| FaxNumber: | 4062340235 | ||||||||
| Practice Location | |||||||||
| Address1: | 2508 WILSON ST | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062341687 | ||||||||
| FaxNumber: | 4062340235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 19347 | MT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.