Provider Demographics
NPI:1841452810
Name:WHITE, DEREK L (PSYCH ASSOC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:L
Last Name:WHITE
Suffix:
Gender:M
Credentials:PSYCH ASSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5820
Mailing Address - Country:US
Mailing Address - Phone:225-925-0445
Mailing Address - Fax:225-925-1987
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5820
Practice Address - Country:US
Practice Address - Phone:225-925-0445
Practice Address - Fax:225-925-1987
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent