Provider Demographics
NPI:1649355579
Name:WHITE, KATHLEEN M (LCSW, LPC, LCDC, LMF)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW, LPC, LCDC, LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 2517
Mailing Address - Street 2:
Mailing Address - City:UNVIERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148
Mailing Address - Country:US
Mailing Address - Phone:210-658-7337
Mailing Address - Fax:210-658-7367
Practice Address - Street 1:1201 PAT BOOKER RD.
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148
Practice Address - Country:US
Practice Address - Phone:210-658-7337
Practice Address - Fax:210-658-7367
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7314101YP2500X
TXS006191041C0700X
TX002231-033222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034216Medicare UPIN
TX00S15JMedicare UPIN