Provider Demographics
NPI:1912056441
Name:WHITE, H. ROGER (MED, MA)
Entity Type:Individual
Prefix:MR
First Name:H.
Middle Name:ROGER
Last Name:WHITE
Suffix:
Gender:M
Credentials:MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SIERRA CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3122
Mailing Address - Country:US
Mailing Address - Phone:972-614-4455
Mailing Address - Fax:
Practice Address - Street 1:704 SIERRA CT
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3122
Practice Address - Country:US
Practice Address - Phone:972-614-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health