Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 370 | OK |
NPI | 1083722532 |
---|---|
Provider Name | Dr. Jerry Don White |
First Address | Oklahoma City, OK 73112-7227 |
Second Address | Oklahoma City, OK 73112-7227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |