Provider Demographics
NPI:1356058234
Name:WHITE, IREEN M
Entity type:Individual
Prefix:
First Name:IREEN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2241
Mailing Address - Country:US
Mailing Address - Phone:309-832-1786
Mailing Address - Fax:773-739-9080
Practice Address - Street 1:2046 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2241
Practice Address - Country:US
Practice Address - Phone:309-832-1786
Practice Address - Fax:773-739-9080
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health