Healthcare Provider Details

I. General information

NPI: 1336655919
Provider Name (Legal Business Name): JERI YVONNE ALLEN-WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BERCUT DR
SACRAMENTO CA
95811-0131
US

IV. Provider business mailing address

9384 BOWMONT WAY
ELK GROVE CA
95758-6549
US

V. Phone/Fax

Practice location:
  • Phone: 916-440-1500
  • Fax: 916-440-1514
Mailing address:
  • Phone: 209-327-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAP6536
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC6536
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: