Provider Demographics
NPI:1225846587
Name:WHITE, TERESA (MS, LPC-A, NCC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 CHISHOLM HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RHOME
Mailing Address - State:TX
Mailing Address - Zip Code:76078-3121
Mailing Address - Country:US
Mailing Address - Phone:940-389-5167
Mailing Address - Fax:940-389-5167
Practice Address - Street 1:313 E ROCK ISLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023-3038
Practice Address - Country:US
Practice Address - Phone:940-389-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional