Provider Demographics
NPI:1649383167
Name:WHITE, FRANK G (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:FRANK
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:PROF
Other - First Name:FRANK
Other - Middle Name:G
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMFT
Mailing Address - Street 1:100 RANDOM OAK CV
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-9680
Mailing Address - Country:US
Mailing Address - Phone:601-853-1875
Mailing Address - Fax:
Practice Address - Street 1:931 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3912
Practice Address - Country:US
Practice Address - Phone:601-832-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist