Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1886 | KS |
NPI | 1114231651 |
---|---|
Provider Name | Dr. Timothy John White |
First Address | Newton, KS 67114-5602 |
Second Address | Newton, KS 67114-5602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |