Provider Demographics
NPI:1073751301
Name:WHITE, TERESA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 SOUTHERN HILLS CTR
Mailing Address - Street 2:PMB400
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2955
Mailing Address - Country:US
Mailing Address - Phone:945-328-7170
Mailing Address - Fax:314-667-3621
Practice Address - Street 1:15 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3809
Practice Address - Country:US
Practice Address - Phone:945-328-7170
Practice Address - Fax:314-667-3621
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22238101YM0800X, 101YP2500X
UT13276553-6004101YP2500X
OHE.2303663101YP2500X
NVCP5528-R101YP2500X
KS2037101YP2500X
NE2900101YP2500X
MO2011039625101YP2500X
ARP2307005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty