Healthcare Provider Details

I. General information

NPI: 1336307693
Provider Name (Legal Business Name): TOMMIE LEE WHITE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 CENTER DR W 500
LOS ANGELES CA
90045-1582
US

IV. Provider business mailing address

6635 KENTWOOD BLUFFS DR
WESTCHESTER CA
90045-1260
US

V. Phone/Fax

Practice location:
  • Phone: 310-486-8476
  • Fax: 310-417-8908
Mailing address:
  • Phone: 310-410-1426
  • Fax: 310-417-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY#9968
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY#9968
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY#9968
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPSY#9968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: