Healthcare Provider Details

I. General information

NPI: 1891237897
Provider Name (Legal Business Name): ALLISON WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 SW EMKAY DR STE 101
BEND OR
97702-3162
US

IV. Provider business mailing address

1011 SW EMKAY DR STE 101
BEND OR
97702-3162
US

V. Phone/Fax

Practice location:
  • Phone: 458-836-5188
  • Fax:
Mailing address:
  • Phone: 458-836-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74162
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10374
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: