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General NPI Number Information
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NPI Number | 1780068270
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Entity Type | Individual
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Provider Name | MATTHEW P WHITE LMFT, MDIV
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Gender | Male
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 8772 BLACKMAN RD
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City | KINGSLEY
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State | MI
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Zip | 49649-9646
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Country | US
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Telephone | 231-944-5907
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Fax |
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Provider Business Mailing Address
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Address Line | 8772 BLACKMAN RD
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City | KINGSLEY
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State | MI
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Zip | 49649-9646
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Country | US
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Telephone | 502-509-1342
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 252320
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101007335
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License Number State | MI
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