Provider Demographics
NPI:1568913317
Name:WHITE, MARIO (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 6TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1439
Mailing Address - Country:US
Mailing Address - Phone:360-930-9440
Mailing Address - Fax:
Practice Address - Street 1:843 6TH ST STE 220
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1439
Practice Address - Country:US
Practice Address - Phone:360-930-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60656337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health