Provider Demographics
NPI:1588319909
Name:WHITE, DAVID OWEN (PLPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:OWEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 VIENNA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-4627
Mailing Address - Country:US
Mailing Address - Phone:806-753-7068
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWATER PT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-442-2612
Practice Address - Fax:636-265-2905
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021014868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional