Provider Demographics
NPI:1598084857
Name:WHITE, ROBERT GLENN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLENN
Last Name:WHITE
Suffix:JR
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 1:1223 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3309
Mailing Address - Country:US
Mailing Address - Phone:580-380-3250
Mailing Address - Fax:580-931-9044
Practice Address - Street 1:1223 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3309
Practice Address - Country:US
Practice Address - Phone:580-380-3250
Practice Address - Fax:580-931-9044
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst