Provider Demographics
NPI:1336307693
Name:WHITE, TOMMIE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TOMMIE
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 KENTWOOD BLUFFS DR
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1260
Mailing Address - Country:US
Mailing Address - Phone:310-410-1426
Mailing Address - Fax:310-417-8908
Practice Address - Street 1:6601 CENTER DR W
Practice Address - Street 2:500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1582
Practice Address - Country:US
Practice Address - Phone:310-486-8476
Practice Address - Fax:310-417-8908
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#9968103T00000X, 103TB0200X, 103TC1900X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports