Provider Demographics
NPI:1831394204
Name:WHITE, SUE C (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 ROYAL AVE
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4665
Mailing Address - Country:US
Mailing Address - Phone:805-578-0378
Mailing Address - Fax:805-579-8515
Practice Address - Street 1:2045 ROYAL AVE
Practice Address - Street 2:SUITE 210A
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4665
Practice Address - Country:US
Practice Address - Phone:805-578-0378
Practice Address - Fax:805-579-8515
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist