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General NPI Number Information
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NPI Number | 1629028980
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Entity Type | Individual
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Provider Name | MARK WHITE MS
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 322 ELTON HILLS DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-2476
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Country | US
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Telephone | 507-226-0002
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Fax | 507-226-0003
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Provider Business Mailing Address
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Address Line | 25094 600TH AVE
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City | BROWNSDALE
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State | MN
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Zip | 55918-8502
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Country | US
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Telephone | 507-259-8107
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Fax | 507-266-0003
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 903
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License Number State | MN
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