Healthcare Provider Details

I. General information

NPI: 1346414141
Provider Name (Legal Business Name): MARILYN H. WHITE, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501B W ASH ST
COLUMBIA MO
65203-4609
US

IV. Provider business mailing address

2501B W ASH ST
COLUMBIA MO
65203-4609
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-4162
  • Fax: 573-442-4162
Mailing address:
  • Phone: 573-442-4162
  • Fax: 573-442-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY00713
License Number StateMO

VIII. Authorized Official

Name: DR. MARILYN H. WHITE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 573-443-2871