Healthcare Provider Details

I. General information

NPI: 1730682535
Provider Name (Legal Business Name): TANYA EULANDA WHITE ED.S., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA E RILEY

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21150 DETTMERING ST
MATTESON IL
60443-2517
US

IV. Provider business mailing address

14915 MAIN ST
HARVEY IL
60426-2235
US

V. Phone/Fax

Practice location:
  • Phone: 708-752-6855
  • Fax:
Mailing address:
  • Phone: 708-596-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180018540
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2483985
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: