Provider Demographics
NPI:1609206374
Name:WHITE, PAULA G
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:G
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 BAYOU SIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7830
Mailing Address - Country:US
Mailing Address - Phone:985-688-8193
Mailing Address - Fax:985-851-7579
Practice Address - Street 1:4135 BAYOU SIDE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7830
Practice Address - Country:US
Practice Address - Phone:985-688-8193
Practice Address - Fax:985-851-7579
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst