Provider Demographics
NPI:1932939675
Name:MAKAEL WHITE PLLC
Entity type:Organization
Organization Name:MAKAEL WHITE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RELATIONAL ART THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, ATR - BC
Authorized Official - Phone:253-290-3762
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:206-348-9385
Mailing Address - Fax:
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:206-348-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2250928Medicaid