Healthcare Provider Details

I. General information

NPI: 1063284487
Provider Name (Legal Business Name): JOSEPH WHITE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WOODHAVEN DR
POLK CITY IA
50226-2054
US

IV. Provider business mailing address

108 WOODHAVEN DR
POLK CITY IA
50226-2054
US

V. Phone/Fax

Practice location:
  • Phone: 319-360-7233
  • Fax:
Mailing address:
  • Phone: 319-360-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number134095
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: