Healthcare Provider Details

I. General information

NPI: 1932939675
Provider Name (Legal Business Name): MAKAEL WHITE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 25TH AVE
LONGVIEW WA
98632-1321
US

IV. Provider business mailing address

447 25TH AVE
LONGVIEW WA
98632-1321
US

V. Phone/Fax

Practice location:
  • Phone: 206-348-9385
  • Fax:
Mailing address:
  • Phone: 206-348-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAKAEL LEE WHITE
Title or Position: RELATIONAL ART THERAPIST/OWNER
Credential: LMFT, ATR - BC
Phone: 253-290-3762