=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043509854
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TED JOSEPH WHITE LMHP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2011
-----------------------------------------------------
Last Update Date | 04/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8563 S 102ND ST
-----------------------------------------------------
City | LA VISTA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68128-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-651-8670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1941 S 42ND ST STE 129
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68105-2938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-871-9979
-----------------------------------------------------
Fax | 402-614-9947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 3876
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------