Provider Demographics
NPI:1639342488
Name:MARIKAY D. WHITE, LCSW, PC
Entity Type:Organization
Organization Name:MARIKAY D. WHITE, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIKAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-841-4005
Mailing Address - Street 1:19731 E PIKES PEAK CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7401
Mailing Address - Country:US
Mailing Address - Phone:303-841-4005
Mailing Address - Fax:720-851-8379
Practice Address - Street 1:19731 E PIKES PEAK CT
Practice Address - Street 2:SUITE 201
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7401
Practice Address - Country:US
Practice Address - Phone:303-841-4005
Practice Address - Fax:720-851-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9923161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
041164Medicare PIN