=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104309848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOWARD ALLEN WHITE ED.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2018
-----------------------------------------------------
Last Update Date | 09/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8305 GROVELAND RD
-----------------------------------------------------
City | HOLLY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48442-9469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-634-0446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 899
-----------------------------------------------------
City | ORTONVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48462-0899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-634-0446
-----------------------------------------------------
Fax | 248-634-0446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6801020431
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------