Provider Demographics
NPI:1952861239
Name:WHITE, ELIZABETH KATHLEEN (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD, ABPP
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 844
Mailing Address - Street 2:
Mailing Address - City:CEDAR GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:92321-0844
Mailing Address - Country:US
Mailing Address - Phone:661-478-9799
Mailing Address - Fax:
Practice Address - Street 1:27307 STATE HWY 189
Practice Address - Street 2:#102
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:661-478-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical