Provider Demographics
NPI:1962558965
Name:WHITE, RUSSELL W (LPC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:W
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 HIGHLAND RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7171
Mailing Address - Country:US
Mailing Address - Phone:214-320-9202
Mailing Address - Fax:214-320-1050
Practice Address - Street 1:3465 HIGHLAND RD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7171
Practice Address - Country:US
Practice Address - Phone:214-320-9202
Practice Address - Fax:214-320-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional