Provider Demographics
NPI:1689880221
Name:WHITE, MARK ALLEN (MMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5404
Mailing Address - Country:US
Mailing Address - Phone:806-785-1697
Mailing Address - Fax:
Practice Address - Street 1:3311 81ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2043
Practice Address - Country:US
Practice Address - Phone:806-780-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist