Provider Demographics
NPI:1720098726
Name:WHITE, KRIS EDDY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KRIS
Middle Name:EDDY
Last Name:WHITE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5168 VILLAGE CREEK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5064
Mailing Address - Country:US
Mailing Address - Phone:972-985-7600
Mailing Address - Fax:972-248-7048
Practice Address - Street 1:5168 VILLAGE CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5064
Practice Address - Country:US
Practice Address - Phone:972-985-7600
Practice Address - Fax:972-248-7048
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical