Doctor Name: | EDWARD WHITE |
NPI Number: | 1003279472 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | LPCC0014070 |
Business Practice Address: | 5555 Erindale Dr Suite 204 Colorado Springs, CO - 809186736 |
Business Phone Number: | 7196864635 |
Business Fax Number: | |
Mailing Address: | 5555 Erindale Dr, Suite 204 COLORADO SPRINGS |
State: | CO |
Postal Code: | 809186736 |
Phone Number: | 7196864635 |
Fax Number: | |
NPI Enumeration Date: | 04/01/2016 |
NPI Last Update Date: | 04/01/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPCC0014070 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |