Provider Demographics
NPI:1275990012
Name:WHITE, CODY (LCPC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5203
Mailing Address - Country:US
Mailing Address - Phone:773-637-0487
Mailing Address - Fax:773-637-1740
Practice Address - Street 1:5825 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5203
Practice Address - Country:US
Practice Address - Phone:773-637-0487
Practice Address - Fax:773-637-1740
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008867101Y00000X
IL180010129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor