Provider Demographics
NPI:1801261292
Name:WHITE, KELLY H (MA, MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, MED, LPC, NCC
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 534
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-0534
Mailing Address - Country:US
Mailing Address - Phone:318-278-7904
Mailing Address - Fax:
Practice Address - Street 1:201 W LEAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4253
Practice Address - Country:US
Practice Address - Phone:318-278-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2599101YP2500X
LA5580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional