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General NPI Number Information
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NPI Number | 1366090680
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Entity Type | Organization
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Legal Business Name | JASON K. WHITE, PH.D., LLC
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 807 S. PINE ST.
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-614-2846
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Fax | 405-533-2888
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Provider Business Mailing Address
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Address Line | 807 S. PINE ST.
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-614-2846
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Fax | 405-533-2888
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JASON KENT WHITE
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Credential | PH.D.
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Telephone | 405-614-2846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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