Provider Demographics
NPI:1154779320
Name:WHITE, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 W. BELDEN AVE
Mailing Address - Street 2:UNIT #G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3555
Mailing Address - Country:US
Mailing Address - Phone:405-831-3773
Mailing Address - Fax:
Practice Address - Street 1:3434 W BELDEN AVE
Practice Address - Street 2:UNIT #G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3555
Practice Address - Country:US
Practice Address - Phone:405-831-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-29
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional