MEDICARE: MS. KELLEE WHITE MA

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	106H00000X	Marriage & Family Therapist	85897	CA

General Provider Information

NPI Number	:	1487295465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLEE WHITE MA

Provider Business Mailing Address
First Line	:	816 S ROBERTSON BLVD FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1601
Country	:	US
Telephone Number	:	562-221-8328
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 S ROBERTSON BLVD FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1601
Country	:	US
Telephone Number	:	562-221-8328
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	10/01/2019

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