Provider Demographics
NPI:1346564598
Name:WHITE, TORI LYNN (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:TORI
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 N BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2501
Mailing Address - Country:US
Mailing Address - Phone:918-413-2058
Mailing Address - Fax:
Practice Address - Street 1:2104 N BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2501
Practice Address - Country:US
Practice Address - Phone:918-413-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool