Provider Demographics
NPI:1508976309
Name:WHITE, RAY A (LPC MSHP)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC MSHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:401 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-639-7011
Practice Address - Fax:423-636-8365
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC139101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3085370OtherMAGELLAN NAVIGATOR
334969OtherVALUEOPTIONS
94774OtherCIGNA MCC
3085370OtherMAGELLAN PINNACLE
3085370OtherMAGELLAN SUMMIT
121752OtherMANAGED HEALTH NET
12864OtherUBH HEALTHPLAN