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General NPI Number Information
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NPI Number | 1063535532
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Entity Type | Individual
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Provider Name | TERESA GAIL WHITE M.S. LADC, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 1219 K ST. SUITE 2
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City | ARDMORE
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State | OK
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Zip | 73401-9999
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Country | US
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Telephone | 580-798-4523
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Fax | 580-319-4523
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Provider Business Mailing Address
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Address Line | 1219 K ST. SUITE 2
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City | ARDMORE
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State | OK
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Zip | 73401-9999
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Country | US
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Telephone | 580-798-4523
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Fax | 580-319-4523
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5115
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 957
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License Number State | OK
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