Provider Demographics
NPI:1194052928
Name:WHITE, JENIFER LORRAINE (MS)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:LORRAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E 17TH PL
Mailing Address - Street 2:APT.. 2
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-7014
Mailing Address - Country:US
Mailing Address - Phone:918-425-4200
Mailing Address - Fax:
Practice Address - Street 1:3604 N CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1536
Practice Address - Country:US
Practice Address - Phone:918-425-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)