Provider Demographics
NPI:1780068270
Name:WHITE, MATTHEW P (LMFT, MDIV)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMFT, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8772 BLACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9646
Mailing Address - Country:US
Mailing Address - Phone:502-509-1342
Mailing Address - Fax:
Practice Address - Street 1:8772 BLACKMAN RD
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9646
Practice Address - Country:US
Practice Address - Phone:231-944-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252320106H00000X, 106H00000X
MI4101007335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist