Provider Demographics
NPI:1023362043
Name:CORNELIUS-WHITE, JEFFREY H (LPC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:CORNELIUS-WHITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 S PARKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1971
Mailing Address - Country:US
Mailing Address - Phone:417-522-9990
Mailing Address - Fax:
Practice Address - Street 1:1322 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1445
Practice Address - Country:US
Practice Address - Phone:417-522-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006003158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional