Healthcare Provider Details

I. General information

NPI: 1588325476
Provider Name (Legal Business Name): ANTHONY GUYTONO WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 W REYNOLDS AVE
CENTRALIA WA
98531-4554
US

IV. Provider business mailing address

1014 N SCHEUBER RD APT 42
CENTRALIA WA
98531-1570
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9044
  • Fax: 360-736-3139
Mailing address:
  • Phone: 360-304-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1588324576
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: