Provider Demographics
NPI:1346481306
Name:WHITE, WALDEN SHELBY (LPC)
Entity Type:Individual
Prefix:MR
First Name:WALDEN
Middle Name:SHELBY
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SANDALWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-0453
Mailing Address - Country:US
Mailing Address - Phone:936-875-6301
Mailing Address - Fax:
Practice Address - Street 1:235 SANDALWOOD ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-0453
Practice Address - Country:US
Practice Address - Phone:936-875-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health