Provider Demographics
NPI:1922158286
Name:WHITE, KATHLEEN F (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:F
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 64TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5590
Mailing Address - Country:US
Mailing Address - Phone:941-792-3042
Mailing Address - Fax:941-745-5667
Practice Address - Street 1:3817 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9041
Practice Address - Country:US
Practice Address - Phone:941-745-5111
Practice Address - Fax:941-745-5667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health