Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003008004 |
---|---|
Provider Name | Ms. Martha White |
First Address | Phoenix, AZ 85015-5101 |
Second Address | Phoenix, AZ 85017-5291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |