Provider Demographics
NPI:1497304570
Name:WHITE, MELANNIE
Entity type:Individual
Prefix:
First Name:MELANNIE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 LONNIE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-3017
Mailing Address - Country:US
Mailing Address - Phone:916-471-9673
Mailing Address - Fax:
Practice Address - Street 1:911 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3819
Practice Address - Country:US
Practice Address - Phone:775-434-8418
Practice Address - Fax:775-799-3337
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP6026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health