Provider Demographics
NPI:1013496413
Name:WHITE, SHIRELL RENEE (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRELL
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:SHIRELL
Other - Middle Name:RENEE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13261 PEARL CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1719
Mailing Address - Country:US
Mailing Address - Phone:720-588-9190
Mailing Address - Fax:
Practice Address - Street 1:2605 W 144TH AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-6203
Practice Address - Country:US
Practice Address - Phone:720-588-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.0013019OtherLPC