Provider Demographics
NPI:1265875124
Name:WHITE, SAMANTHA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SWINGLE BUILDING
Mailing Address - Street 2:MONTANA STATE UNIVERSITY
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59717-3180
Mailing Address - Country:US
Mailing Address - Phone:406-994-4531
Mailing Address - Fax:406-994-2485
Practice Address - Street 1:211 SWINGLE BUILDING
Practice Address - Street 2:MONTANA STATE UNIVERSITY
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59717-3180
Practice Address - Country:US
Practice Address - Phone:406-994-4531
Practice Address - Fax:406-994-2485
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical