Provider Demographics
NPI:1588715346
Name:WHITE, JACQUELYN N (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 BENT OAKS CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8000
Mailing Address - Country:US
Mailing Address - Phone:214-587-6025
Mailing Address - Fax:940-380-4030
Practice Address - Street 1:1204 BENT OAKS CT
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8000
Practice Address - Country:US
Practice Address - Phone:214-587-6025
Practice Address - Fax:940-380-4030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health