Provider Demographics
NPI:1295742799
Name:WHITE, EARL EDMUND (MFT)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:EDMUND
Last Name:WHITE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MAGELLAN ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2318
Mailing Address - Country:US
Mailing Address - Phone:831-460-2550
Mailing Address - Fax:831-688-1718
Practice Address - Street 1:3060 VALENCIA AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4165
Practice Address - Country:US
Practice Address - Phone:831-460-2550
Practice Address - Fax:831-688-1718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT2386106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist