Healthcare Provider Details

I. General information

NPI: 1891251724
Provider Name (Legal Business Name): WHITNEY WHITE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CHINOOK LN
PUEBLO CO
81001-1851
US

IV. Provider business mailing address

41 MONTEBELLO RD
PUEBLO CO
81001-1379
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-2746
  • Fax: 719-543-4447
Mailing address:
  • Phone: 719-545-2746
  • Fax: 719-545-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0018525
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: