Healthcare Provider Details

I. General information

NPI: 1760961734
Provider Name (Legal Business Name): MRS. SHARION LENESE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12514 BERRY LAUREL LANE
HOUSTON TX
77014
US

IV. Provider business mailing address

12514 BERRY LAUREL LANE
HOUSTON TX
77014
US

V. Phone/Fax

Practice location:
  • Phone: 832-596-9934
  • Fax:
Mailing address:
  • Phone: 832-596-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: