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General NPI Number Information
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NPI Number | 1275990012
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Entity Type | Individual
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Provider Name | CODY WHITE LCPC
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Gender | Male
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 5825 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5203
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Country | US
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Telephone | 773-637-0487
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Fax | 773-637-1740
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Provider Business Mailing Address
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Address Line | 5825 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5203
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Country | US
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Telephone | 773-637-0487
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Fax | 773-637-1740
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178008867
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License Number State | IL
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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 | 180010129
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License Number State | IL
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