Healthcare Provider Details

I. General information

NPI: 1649383167
Provider Name (Legal Business Name): FRANK G WHITE LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FRANK G. WHITE LCMFT

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HIGHWAY 80 W
JACKSON MS
39204-3912
US

IV. Provider business mailing address

100 RANDOM OAK CV
RAYMOND MS
39154-9680
US

V. Phone/Fax

Practice location:
  • Phone: 601-832-1875
  • Fax:
Mailing address:
  • Phone: 601-853-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0385
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: