Provider Demographics
NPI:1497904965
Name:WHITE, KARLA JEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 W WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9519
Mailing Address - Country:US
Mailing Address - Phone:309-368-6505
Mailing Address - Fax:
Practice Address - Street 1:3915 N SHERIDAN RD UNIT R
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7135
Practice Address - Country:US
Practice Address - Phone:309-681-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional