Provider Demographics
NPI:1457491318
Name:WHITE, KEITH ALAN (MALPC / LCPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:MALPC / LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1703
Mailing Address - Country:US
Mailing Address - Phone:816-765-8211
Mailing Address - Fax:816-765-8215
Practice Address - Street 1:12505 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030
Practice Address - Country:US
Practice Address - Phone:816-765-8211
Practice Address - Fax:816-765-8215
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional