Provider Demographics
NPI:1851644496
Name:WHITE, MICHAEL YARBROUGH JR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YARBROUGH
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 N NELLIS BLVD APT 158
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-5562
Mailing Address - Country:US
Mailing Address - Phone:702-741-5246
Mailing Address - Fax:
Practice Address - Street 1:2068 N NELLIS BLVD APT 158
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-5562
Practice Address - Country:US
Practice Address - Phone:702-741-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst