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General NPI Number Information
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NPI Number | 1013496413
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Entity Type | Individual
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Provider Name | SHIRELL RENEE WHITE LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 2605 W 144TH AVE
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City | BROOMFIELD
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State | CO
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Zip | 80023-6203
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Country | US
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Telephone | 720-588-9190
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Fax |
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Provider Business Mailing Address
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Address Line | 13261 PEARL CIR
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City | THORNTON
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State | CO
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Zip | 80241-1719
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Country | US
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Telephone | 720-588-9190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0013019
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License Number State | CO
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