Healthcare Provider Details

I. General information

NPI: 1396650388
Provider Name (Legal Business Name): DRAKE WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S HICO ST
SILOAM SPRINGS AR
72761-3740
US

IV. Provider business mailing address

1013 RED OAK LOOP
ELM SPRINGS AR
72762-4557
US

V. Phone/Fax

Practice location:
  • Phone: 501-503-1890
  • Fax:
Mailing address:
  • Phone: 501-388-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2608010
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2608010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: