Provider Demographics
NPI:1538046347
Name:WHITE, NICHOLAS TREYMANE
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TREYMANE
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 JAMIE LN
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4134
Mailing Address - Country:US
Mailing Address - Phone:708-314-1859
Mailing Address - Fax:
Practice Address - Street 1:1148 JAMIE LN
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4134
Practice Address - Country:US
Practice Address - Phone:708-314-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25-420281106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician