Provider Demographics
NPI:1285998633
Name:WHITE, ANITA W (M ED)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:W
Last Name:WHITE
Suffix:
Gender:F
Credentials:M ED
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 869
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:OK
Mailing Address - Zip Code:74436-0869
Mailing Address - Country:US
Mailing Address - Phone:918-348-5655
Mailing Address - Fax:
Practice Address - Street 1:17897 W 10TH ST N
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:OK
Practice Address - Zip Code:74436-9462
Practice Address - Country:US
Practice Address - Phone:918-348-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)