Provider Demographics
NPI:1457393217
Name:WHITE, ROY (PHD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
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 1:3 CLEARVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MOSELLE
Mailing Address - State:MS
Mailing Address - Zip Code:39459-9520
Mailing Address - Country:US
Mailing Address - Phone:601-544-1499
Mailing Address - Fax:601-544-8464
Practice Address - Street 1:3 CLEARVIEW CIR
Practice Address - Street 2:
Practice Address - City:MOSELLE
Practice Address - State:MS
Practice Address - Zip Code:39459-9520
Practice Address - Country:US
Practice Address - Phone:601-544-1499
Practice Address - Fax:601-544-8464
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS51 884103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201742OtherBLUE CROSS BLUE SHIELD