Provider Demographics
NPI:1578196150
Name:WHITE, AMBER (LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 E INDIAN SCHOOL RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0703
Mailing Address - Country:US
Mailing Address - Phone:424-465-3058
Mailing Address - Fax:888-434-5444
Practice Address - Street 1:2633 E INDIAN SCHOOL RD
Practice Address - Street 2:STE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-0703
Practice Address - Country:US
Practice Address - Phone:424-465-3058
Practice Address - Fax:888-434-5444
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16073101YA0400X
AZ17868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)