Provider Demographics
NPI:1679988083
Name:WHITE, MAUREEN (PHD)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2150 KESAEHKAHTEK
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:WI
Mailing Address - Zip Code:54128-2150
Mailing Address - Country:US
Mailing Address - Phone:715-799-3835
Mailing Address - Fax:715-799-5056
Practice Address - Street 1:N2150 KESAEHKAHTEK
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:WI
Practice Address - Zip Code:54128-2150
Practice Address - Country:US
Practice Address - Phone:715-799-3835
Practice Address - Fax:715-799-5056
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling