MEDICARE: ALEXANDER HENRY WHITE CMHC

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	101YM0800X	Mental Health Counselor	11125312-6004	UT

General Provider Information

NPI Number	:	1427640077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER HENRY WHITE CMHC

Provider Business Mailing Address
First Line	:	1201 E 5730 S
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84121-1669
Country	:	US
Telephone Number	:	801-382-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 E SOUTH TEMPLE STE 100F
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1159
Country	:	US
Telephone Number	:	801-382-8409
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	12/30/2023

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