=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780725390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEARLEAN WHITE AMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13001 RAMONA BLVD
-----------------------------------------------------
City | IRWINDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91706-3752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-421-8127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1144 FOREST AVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91103-2836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-421-8127
-----------------------------------------------------
Fax | 626-421-8127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 150881
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------