Provider Demographics
NPI:1194376061
Name:WHITE, KARIS NICOLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 COUNTY ROAD 204
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-7002
Mailing Address - Country:US
Mailing Address - Phone:806-620-0842
Mailing Address - Fax:
Practice Address - Street 1:9400 COUNTY ROAD 204
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-7002
Practice Address - Country:US
Practice Address - Phone:806-620-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014514101YP2500X
COLPC.0014514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty