| Doctor Name: | KELLEY WHITE |
| NPI Number: | 1043336589 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2005038988 |
| Business Practice Address: | 104 W Jackson St B Bolivar, MO - 656131902 |
| Business Phone Number: | 4177771458 |
| Business Fax Number: | |
| Mailing Address: | 4733 S Robberson Ave, Apt. 101 H SPRINGFIELD |
| State: | MO |
| Postal Code: | 658101786 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2005038988 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |