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NPI Code Detail

MEDICARE: THERESA WHITE LCPC

MEDICARE:   THERESA  WHITE  LCPC
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 Counselor19347MT

General Provider Information

NPI Number : 1417063298
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA WHITE LCPC
Provider Business Mailing Address
First Line : 2508 WILSON ST
Second Line :
City : MILES CITY
State : MT
Zip : 59301-5000
Country : US
Telephone Number : 406-234-1687
Fax Number : 406-234-0235
Provider Business Practice Location Address
First Line : 2508 WILSON ST
Second Line :
City : MILES CITY
State : MT
Zip : 59301-5000
Country : US
Telephone Number : 406-234-1687
Fax Number : 406-234-0235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 10/12/2016

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Directions to “ THERESA WHITE LCPC” Practice Location

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