Provider Demographics
NPI:1154536324
Name:WHITE, THELMA JEAN (LBSW, MSW)
Entity type:Individual
Prefix:MS
First Name:THELMA
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LBSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:KYKOTSMOVI
Mailing Address - State:AZ
Mailing Address - Zip Code:86039-0206
Mailing Address - Country:US
Mailing Address - Phone:928-458-6719
Mailing Address - Fax:
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLBSW-11358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker