MEDICARE: D L WHITE PSYCHOLOGICAL SERVICES LTD

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		IL

General Provider Information

NPI Number	:	1548356371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D L WHITE PSYCHOLOGICAL SERVICES LTD

Provider Business Mailing Address
First Line	:	330 W DIVERSEY PKWY APT 1803
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-296-1827
Fax Number	:	773-529-1253

Provider Business Practice Location Address
First Line	:	3405 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3819
Country	:	US
Telephone Number	:	312-791-0035
Fax Number	:	312-791-0626

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. DONALD LAWRENCE WHITE
Credential	:	PH.D.
Telephone Number	:	773-502-5950

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/23/2008

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