Provider Demographics
NPI:1104263383
Name:WHITE, COURTNEY (IBCLC, CLE, CIMI)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:IBCLC, CLE, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HIGHLAND MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5736
Mailing Address - Country:US
Mailing Address - Phone:469-569-9917
Mailing Address - Fax:
Practice Address - Street 1:139 OAKBROOK DR
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4033
Practice Address - Country:US
Practice Address - Phone:469-569-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
TX11093949174N00000X
TX374J00000X
253Z00000X, 390200000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
No253Z00000XAgenciesIn Home Supportive Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No174400000XOther Service ProvidersSpecialist