MEDICARE: CHARITY WHITE MPA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103K00000X	Behavior Analyst
3	106S00000X	Behavior Technician
4	171M00000X	Case Manager/Care Coordinator
5	172A00000X	Driver
6	251C00000X	Developmentally Disabled Services Day Training Agency
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
8	385H00000X	Respite Care
9	174400000X	Specialist

General Provider Information

NPI Number	:	1679412027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY WHITE MPA

Provider Business Mailing Address
First Line	:	2109 WENGERT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 WENGERT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2033
Country	:	US
Telephone Number	:	702-600-9481
Fax Number	:

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

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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Directions to “ CHARITY WHITE MPA” Practice Location

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