Provider Demographics
NPI:1134457476
Name:WHITE, BRENDA K (LCPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W BOUGHTON RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1872
Mailing Address - Country:US
Mailing Address - Phone:312-971-6653
Mailing Address - Fax:
Practice Address - Street 1:402 W BOUGHTON RD
Practice Address - Street 2:SUITE G
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1872
Practice Address - Country:US
Practice Address - Phone:312-971-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.009144OtherSTATE OF ILLINOIS - LCPC