Doctor Name: | MARK ALLEN WHITE |
NPI Number: | 1679746234 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 3984 |
Business Practice Address: | 1025 Meadowbrook Ave Prague, OK - 74864 |
Business Phone Number: | 4053801135 |
Business Fax Number: | |
Mailing Address: | Po Box 465, PRAGUE |
State: | OK |
Postal Code: | 748640465 |
Phone Number: | 4055675542 |
Fax Number: | |
NPI Enumeration Date: | 04/03/2008 |
NPI Last Update Date: | 08/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3984 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |