MEDICARE: CHRISTOPHER J WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0152691	NM
2	103TC0700X	Clinical Psychologist	PSY.0005707	CO

General Provider Information

NPI Number	:	1134404916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER J WHITE

Provider Business Mailing Address
First Line	:	2860 S CIRCLE DR STE 109
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4195
Country	:	US
Telephone Number	:	719-540-2146
Fax Number	:

Provider Business Practice Location Address
First Line	:	9135 RIDGELINE BLVD STE 160
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2395
Country	:	US
Telephone Number	:	719-540-2146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	04/29/2022

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Directions to “ CHRISTOPHER J WHITE ” Practice Location

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