Provider Demographics
NPI:1255415162
Name:WHITE, PAUL E (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
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 1:4850 N 143RD ST E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67228-8949
Mailing Address - Country:US
Mailing Address - Phone:316-733-7841
Mailing Address - Fax:316-689-4299
Practice Address - Street 1:111 S WHITTIER ST
Practice Address - Street 2:SUITE 5300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1045
Practice Address - Country:US
Practice Address - Phone:316-681-4427
Practice Address - Fax:316-689-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist