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NPI Code Detail

MEDICARE: BRET WHITE LCSW

MEDICARE: BRET WHITE LCSW
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
11041C0700XClinical Social Worker001538MO

General Provider Information

NPI Number : 1750422952
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRET WHITE LCSW
Provider Business Mailing Address
First Line : 608 MALLORY DR
Second Line :
City : BELTON
State : MO
Zip : 64012-2040
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 W ASHLAND ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-1710
Country : US
Telephone Number : 417-667-2666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/08/2007

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Directions to “ BRET WHITE LCSW” Practice Location

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