Provider Demographics
NPI:1730650664
Name:WHITE, SIERRA N (IMFT)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 OLENTANGY RIVER RD # 1026
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1453
Mailing Address - Country:US
Mailing Address - Phone:614-754-9500
Mailing Address - Fax:
Practice Address - Street 1:52 N HIGH ST
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-1141
Practice Address - Country:US
Practice Address - Phone:614-453-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.2000143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid