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General NPI Number Information
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NPI Number | 1710123377
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Entity Type | Individual
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Provider Name | LANCE KYLE WHITE LPC
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Gender | Male
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 930 WINGATE ST STE E2
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City | CONWAY
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State | AR
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Zip | 72034-4866
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Country | US
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Telephone | 501-642-0752
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CORNERSTONE DR
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City | GREENBRIER
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State | AR
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Zip | 72058-9269
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Country | US
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Telephone | 501-642-0752
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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 | P1405052
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License Number State | AR
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