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General NPI Number Information
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NPI Number | 1396313185
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Entity Type | Individual
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Provider Name | SHERRY CHAFFIN WHITE SR. LPE
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | BRIGHT BLUE HEALTH CENTER 1055 VENDALL ROAD
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City | DYERSBURG
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State | TN
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Zip | 38024-1622
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Country | US
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Telephone | 731-882-7224
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 STATE ROUTE U
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-2342
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Country | US
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Telephone | 573-757-8600
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0000011525
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License Number State | TN
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