Healthcare Provider Details

I. General information

NPI: 1942710876
Provider Name (Legal Business Name): ALESHA D WHITE LPC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCGEE DR STE 120
NORMAN OK
73072-6705
US

IV. Provider business mailing address

419 W GRAY ST
NORMAN OK
73069-7117
US

V. Phone/Fax

Practice location:
  • Phone: 405-612-6761
  • Fax: 405-364-5379
Mailing address:
  • Phone: 405-329-7300
  • Fax: 405-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6465
License Number StateOK

VIII. Authorized Official

Name: ALESHA D WHITE
Title or Position: MANAGING MEMBER
Credential: LPC
Phone: 405-612-6761