Provider Demographics
NPI:1457815359
Name:WHITE, CHEYENNE (SWLC, LAC)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:SWLC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 2ND ST E STE B28
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4563
Mailing Address - Country:US
Mailing Address - Phone:406-270-6265
Mailing Address - Fax:
Practice Address - Street 1:30 2ND ST E STE B28
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4563
Practice Address - Country:US
Practice Address - Phone:406-270-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-37003101YA0400X
MTBBH-SWLC-LIC-71187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)