MEDICARE: STEPHANIE WHITE COUNSELING SERVICES

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	1041C0700X	Clinical Social Worker	2011041571	MO

General Provider Information

NPI Number	:	1407118912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE WHITE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	5950 N OAK TRFY
Second Line	:	SUITE 104
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 N OAK TRFY
Second Line	:	SUITE 104
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5166
Country	:	US
Telephone Number	:	816-455-7233
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE WHITE
Credential	:	LCSW
Telephone Number	:	816-455-7223

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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