Provider Demographics
NPI:1215070941
Name:WHITE, JAMIE BRENNER (LMFT)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:BRENNER
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10749 W REUTZEL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5029
Mailing Address - Country:US
Mailing Address - Phone:510-565-4442
Mailing Address - Fax:
Practice Address - Street 1:10749 W REUTZEL DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5029
Practice Address - Country:US
Practice Address - Phone:510-565-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT152348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42073Medicaid