=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548655335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA ERIN WHITE MS, LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2015
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 SE FEDERAL HWY STE 334
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-690-6906
-----------------------------------------------------
Fax | 781-399-4945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4550 SE FEDERAL HWY APT 3209
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34997-5771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-222-1752
-----------------------------------------------------
Fax | 781-399-4945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | PC008084
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH24696
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------