MEDICARE: MRS. KATHLEEN F WHITE LMHC

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	MH 8076	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922158286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN F WHITE LMHC

Provider Business Mailing Address
First Line	:	2301 64TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5590
Country	:	US
Telephone Number	:	941-792-3042
Fax Number	:	941-745-5667

Provider Business Practice Location Address
First Line	:	3817 E STATE ROAD 64
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-9041
Country	:	US
Telephone Number	:	941-745-5111
Fax Number	:	941-745-5667

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/09/2007

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