Provider Demographics
NPI:1265512594
Name:WHITE, LORRAINE A (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LORRI
Other - Middle Name:A
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 38298
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80937-8298
Mailing Address - Country:US
Mailing Address - Phone:719-338-6679
Mailing Address - Fax:719-226-8057
Practice Address - Street 1:555 E PIKES PEAK AVE STE 108
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3612
Practice Address - Country:US
Practice Address - Phone:719-338-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1493103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07014939Medicaid
CO301340OtherMAGELLAN
CO8766Medicare UPIN
CO07014939Medicaid