Provider Demographics
NPI:1659318012
Name:SANDRA WHITE
Entity Type:Organization
Organization Name:SANDRA WHITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-675-5990
Mailing Address - Street 1:3301 N 3RD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-7054
Mailing Address - Country:US
Mailing Address - Phone:325-675-5990
Mailing Address - Fax:325-673-9414
Practice Address - Street 1:3301 N 3RD ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-7054
Practice Address - Country:US
Practice Address - Phone:325-675-5990
Practice Address - Fax:325-673-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163973401Medicaid
TX00110WMedicare PIN