Provider Demographics
NPI:1043509854
Name:WHITE, TED JOSEPH (LMHP)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:JOSEPH
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 129
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2938
Mailing Address - Country:US
Mailing Address - Phone:402-871-9979
Mailing Address - Fax:402-614-9947
Practice Address - Street 1:8563 S 102ND ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3229
Practice Address - Country:US
Practice Address - Phone:402-651-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional