Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3088 | AZ |
N | 103T00000X | Psychologist | 3088 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3088 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3088 | AZ |
N | 103G00000X | Clinical Psychologist | 3088 | AZ |
N | 103TC0700X | Clinical Psychologist | 3088 | AZ |
N | 103TE1100X | Exercise & Sports Psychologist | 3088 | AZ |
N | 103TF0000X | Family Psychologist | 3088 | AZ |
N | 103TF0200X | Forensic Psychologist | 3088 | AZ |
N | 103TH0100X | Health Service | 3088 | AZ |
N | 103TP2701X | Group Psychotherapist | 3088 | AZ |
N | 103TR0400X | Rehabilitation Psychologist | 3088 | AZ |
NPI | 1124115647 |
---|---|
Provider Name | Cynthia White |
First Address | Prescott, AZ 86313-9091 |
Second Address | Prescott, AZ 86313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |