Provider Demographics
NPI:1154406585
Name:WHITE, PAUL ANDREW (PSYD, HSPP)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:WHITE
Suffix:
Gender:M
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6060
Mailing Address - Fax:
Practice Address - Street 1:230 CARTER DRIVE
Practice Address - Street 2:BUILDING 718
Practice Address - City:FORT SHAFTER
Practice Address - State:HI
Practice Address - Zip Code:96858
Practice Address - Country:US
Practice Address - Phone:808-787-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041925A103TC0700X
HIPSY-1601103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical