Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1622 | NE |
NPI | 1083773279 |
---|---|
Provider Name | James T. White |
First Address | Bellevue, NE 68005-3444 |
Second Address | Omaha, NE 68105-2939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85102 | BLUE CROSS BLUE SHIELD (01) | NE |