Provider Demographics
NPI:1073016903
Name:WHITE, SHAWN (LPCC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 FAIRWAY STREET
Mailing Address - Street 2:STE 103
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2452
Mailing Address - Country:US
Mailing Address - Phone:407-347-4536
Mailing Address - Fax:812-285-8392
Practice Address - Street 1:1143 FAIRWAY STREET
Practice Address - Street 2:STE 103
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2452
Practice Address - Country:US
Practice Address - Phone:407-347-4536
Practice Address - Fax:812-285-8392
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional