Provider Demographics
NPI:1043920473
Name:WHITE, CORA KATHLEEN
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:KATHLEEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 DOEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0160
Mailing Address - Country:US
Mailing Address - Phone:830-340-1433
Mailing Address - Fax:
Practice Address - Street 1:2115 STEPHENS PL STE 810
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2163
Practice Address - Country:US
Practice Address - Phone:210-985-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician