MEDICARE: DR. PATRICIA A WHITE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY134	NV
2	103TC0700X	Clinical Psychologist	PY134	NV
3	103TC1900X	Counseling Psychologist	PY134	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073666509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA A WHITE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 370286
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137-0286
Country	:	US
Telephone Number	:	702-370-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 CRIMSON CANYON DR
Second Line	:	STE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0845
Country	:	US
Telephone Number	:	702-370-2636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	09/25/2007

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Directions to “ DR. PATRICIA A WHITE PH.D.” Practice Location

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