MEDICARE: JEREMY WHITE LSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	101YS0200X	School Counselor
6	103K00000X	Behavior Analyst
7	104100000X	Social Worker

General Provider Information

NPI Number	:	1407239874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY WHITE LSW

Provider Business Mailing Address
First Line	:	3804 WIND RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6478
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3804 WIND RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6478
Country	:	US
Telephone Number	:	808-927-9977
Fax Number	:

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

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	04/20/2016

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Directions to “ JEREMY WHITE LSW” Practice Location

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