Provider Demographics
NPI:1639406408
Name:WHITE, JUDY (BSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 RED RIO DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8426
Mailing Address - Country:US
Mailing Address - Phone:702-845-0607
Mailing Address - Fax:702-845-0607
Practice Address - Street 1:8700 RED RIO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8426
Practice Address - Country:US
Practice Address - Phone:702-845-0607
Practice Address - Fax:702-845-0607
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health