Healthcare Provider Details

I. General information

NPI: 1376064022
Provider Name (Legal Business Name): ANDREW STEVEN WHITE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SOUTH 70TH STREET SUITE 120
LINCOLN NE
68516
US

IV. Provider business mailing address

4501 SOUTH 70TH STREET SUITE 120
LINCOLN NE
68516
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-1936
  • Fax: 402-483-7314
Mailing address:
  • Phone: 402-483-1936
  • Fax: 402-483-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10948
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1032
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: