Provider Demographics
NPI:1467855585
Name:WHITE, TORY LYNN
Entity Type:Individual
Prefix:
First Name:TORY
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4060
Mailing Address - Country:US
Mailing Address - Phone:719-466-6772
Mailing Address - Fax:719-599-7004
Practice Address - Street 1:5265 N ACADEMY BLVD
Practice Address - Street 2:SUITE 3300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4060
Practice Address - Country:US
Practice Address - Phone:719-466-6772
Practice Address - Fax:719-599-7004
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0013974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist