=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225846587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA WHITE MS, LPC-A, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2024
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 E ROCK ISLAND AVE STE 200
-----------------------------------------------------
City | BOYD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76023-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-389-7095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 580 CHISHOLM HILLS DR
-----------------------------------------------------
City | RHOME
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76078-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-389-5167
-----------------------------------------------------
Fax | 940-389-5167
-----------------------------------------------------
=====================================================
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 | 96907
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------