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NPI Code Detail

MEDICARE: CRYSTAL N WHITE MHCA

MEDICARE: CRYSTAL N WHITE MHCA
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
1101YM0800XMental Health Counselor2633KS

General Provider Information

NPI Number : 1285150904
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL N WHITE MHCA
Provider Business Mailing Address
First Line : 2005 N 103RD AVE UNIT 1204
Second Line :
City : AVONDALE
State : AZ
Zip : 85392-4533
Country : US
Telephone Number : 785-861-0404
Fax Number :
Provider Business Practice Location Address
First Line : 15150 W PARK PL FL 2
Second Line :
City : GOODYEAR
State : AZ
Zip : 85395-2385
Country : US
Telephone Number : 602-679-4691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2017
Last Update Date : 10/03/2025

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Directions to “ CRYSTAL N WHITE MHCA” Practice Location

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