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General NPI Number Information
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NPI Number | 1346564598
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Entity Type | Individual
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Provider Name | TORI LYNN WHITE M.ED. LPC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 2104 N BROADWAY ST SUITE A
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City | POTEAU
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State | OK
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Zip | 74953-2501
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Country | US
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Telephone | 918-413-2058
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 N BROADWAY ST SUITE A
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City | POTEAU
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State | OK
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Zip | 74953-2501
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Country | US
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Telephone | 918-413-2058
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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