MEDICARE: MR. H. ROGER WHITE M.ED., M.A.

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	14831	TX

General Provider Information

NPI Number	:	1912056441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. H. ROGER WHITE M.ED., M.A.

Provider Business Mailing Address
First Line	:	704 SIERRA CT
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3122
Country	:	US
Telephone Number	:	972-614-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 SIERRA CT
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3122
Country	:	US
Telephone Number	:	972-614-4455
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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