Provider Demographics
NPI:1326772989
Name:WHITE, MAKAEL LEE (LMFT, ATR-BC)
Entity type:Individual
Prefix:
First Name:MAKAEL
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMFT, ATR-BC
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:LEIGH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:447 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1321
Mailing Address - Country:US
Mailing Address - Phone:253-290-3762
Mailing Address - Fax:253-390-3033
Practice Address - Street 1:447 25TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1321
Practice Address - Country:US
Practice Address - Phone:253-290-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-217221700000X
WALF61328543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2250928Medicaid