Provider Demographics
NPI:1750066254
Name:WHITE, KEVIN G
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 HUGHES LANDING BLVD APT 616
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3731
Mailing Address - Country:US
Mailing Address - Phone:713-303-3787
Mailing Address - Fax:
Practice Address - Street 1:1950 HUGHES LANDING BLVD APT 616
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3731
Practice Address - Country:US
Practice Address - Phone:171-330-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional