Provider Demographics
NPI:1073872081
Name:WHITE, CATHERINE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S CENTRAL AVE
Mailing Address - Street 2:PO BOX 599
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-6061
Mailing Address - Country:US
Mailing Address - Phone:580-212-9193
Mailing Address - Fax:580-286-3478
Practice Address - Street 1:503 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6061
Practice Address - Country:US
Practice Address - Phone:580-212-9193
Practice Address - Fax:580-286-3478
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional