MEDICARE: PATRICIA A. WHITE, PH.D. LLC

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	103T00000X	Psychologist	PY134	NV

General Provider Information

NPI Number	:	1184811929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICIA A. WHITE, PH.D. LLC

Provider Business Mailing Address
First Line	:	PO BOX 370286
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137-0286
Country	:	US
Telephone Number	:	702-370-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 CRIMSON CANYON DR
Second Line	:	STE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0845
Country	:	US
Telephone Number	:	702-370-2636
Fax Number	:	702-655-3395

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. PATRICIA A WHITE
Credential	:	PH.D.
Telephone Number	:	702-370-2636

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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