Healthcare Provider Details

I. General information

NPI: 1073872081
Provider Name (Legal Business Name): CATHERINE WHITE M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S CENTRAL AVE
IDABEL OK
74745-6061
US

IV. Provider business mailing address

503 S CENTRAL AVE PO BOX 599
IDABEL OK
74745-6061
US

V. Phone/Fax

Practice location:
  • Phone: 580-212-9193
  • Fax: 580-286-3478
Mailing address:
  • Phone: 580-212-9193
  • Fax: 580-286-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5104
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: