Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003101395 |
---|---|
Provider Name | Joanne White |
First Address | Bend, OR 97701-7638 |
Second Address | Bend, OR 97701-7638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 14/06/2011 |