Provider Demographics
NPI:1922191634
Name:WHITE, JOSEPH DALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DALE
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHD
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 15405
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78761-5405
Mailing Address - Country:US
Mailing Address - Phone:512-949-2493
Mailing Address - Fax:512-949-2527
Practice Address - Street 1:6225 E HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1025
Practice Address - Country:US
Practice Address - Phone:512-949-2493
Practice Address - Fax:512-949-2527
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31783103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165970801Medicaid
TX165970801Medicaid