Provider Demographics
NPI:1306340666
Name:WHITE, MEGAN KATELLE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10680 YATES DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-1984
Mailing Address - Country:US
Mailing Address - Phone:303-725-2839
Mailing Address - Fax:
Practice Address - Street 1:2833 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3544
Practice Address - Country:US
Practice Address - Phone:303-449-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO600640720OtherBLUE CROSS BLUE SHIELD