Provider Demographics
NPI:1780661470
Name:WHITE, SHELLEY J (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19178
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-1178
Mailing Address - Country:US
Mailing Address - Phone:806-670-3755
Mailing Address - Fax:806-383-8789
Practice Address - Street 1:5410 BELL ST STE 414
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6222
Practice Address - Country:US
Practice Address - Phone:806-670-3755
Practice Address - Fax:806-383-8789
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0290363-02Medicaid
TX029036301OtherTPMHMR
TX0290363-01Medicaid