Provider Demographics
NPI:1982342150
Name:WHITE, SHANA (M A SCHOOL PSYCH)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:M A SCHOOL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3453
Mailing Address - Country:US
Mailing Address - Phone:307-856-5250
Mailing Address - Fax:
Practice Address - Street 1:121 N 5TH ST W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3453
Practice Address - Country:US
Practice Address - Phone:307-856-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool