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General NPI Number Information
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NPI Number | 1285150904
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Entity Type | Individual
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Provider Name | CRYSTAL N WHITE MHCA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 15150 W PARK PL FL 2
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City | GOODYEAR
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State | AZ
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Zip | 85395-2385
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Country | US
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Telephone | 602-679-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 N 103RD AVE UNIT 1204
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City | AVONDALE
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State | AZ
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Zip | 85392-4533
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Country | US
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Telephone | 785-861-0404
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2633
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License Number State | KS
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