Provider Demographics
NPI:1558603019
Name:WHITE, GJAISON EARL SR
Entity Type:Individual
Prefix:MR
First Name:GJAISON
Middle Name:EARL
Last Name:WHITE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 ASPEN FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1264
Mailing Address - Country:US
Mailing Address - Phone:702-461-7201
Mailing Address - Fax:
Practice Address - Street 1:5737 ASPEN FALLS CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1264
Practice Address - Country:US
Practice Address - Phone:702-461-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health