Provider Demographics
NPI:1487662904
Name:WHITE, MARILYN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:H
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501B W ASH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4609
Mailing Address - Country:US
Mailing Address - Phone:573-442-4161
Mailing Address - Fax:573-442-4162
Practice Address - Street 1:2501B W ASH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4609
Practice Address - Country:US
Practice Address - Phone:573-442-4161
Practice Address - Fax:573-442-4162
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00713103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling