Provider Demographics
NPI:1275747834
Name:WHITE, JAYME MICAH (BA)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:MICAH
Last Name:WHITE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:OK
Mailing Address - Zip Code:74570-0020
Mailing Address - Country:US
Mailing Address - Phone:918-820-0417
Mailing Address - Fax:
Practice Address - Street 1:1151 NORTH HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:STRINGTOWN
Practice Address - State:OK
Practice Address - Zip Code:74569
Practice Address - Country:US
Practice Address - Phone:580-346-7301
Practice Address - Fax:580-346-7214
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)