Healthcare Provider Details

I. General information

NPI: 1457393217
Provider Name (Legal Business Name): ROY WHITE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CLEARVIEW CIR
MOSELLE MS
39459-9520
US

IV. Provider business mailing address

3 CLEARVIEW CIR
MOSELLE MS
39459-9520
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-1499
  • Fax: 601-544-8464
Mailing address:
  • Phone: 601-544-1499
  • Fax: 601-544-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number51 884
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: