Provider Demographics
NPI:1528391000
Name:WHITE, MISTY REBECCA GANCE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:REBECCA GANCE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:R
Other - Last Name:GANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8774 YATES DR STE 305C
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6971
Mailing Address - Country:US
Mailing Address - Phone:720-335-5126
Mailing Address - Fax:
Practice Address - Street 1:8774 YATES DR STE 305C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6971
Practice Address - Country:US
Practice Address - Phone:720-335-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91020514Medicaid