Provider Demographics
NPI:1588615850
Name:WHITE, KATHLYN CAMPBELL (LMHC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLYN
Middle Name:CAMPBELL
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5383
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-5383
Mailing Address - Country:US
Mailing Address - Phone:850-897-7810
Mailing Address - Fax:850-897-0032
Practice Address - Street 1:4400 E HIGHWAY 20
Practice Address - Street 2:SUITE 306
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8779
Practice Address - Country:US
Practice Address - Phone:850-897-7810
Practice Address - Fax:850-897-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2301106H00000X
FLMH6265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2177561OtherCIGNA
FLZ0741OtherBCBS ID
FL7153709OtherAETNA