Individual
JONATHAN BLAKE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2706 N BROADWAY ST, POTEAU, OK 74953-5402
(918) 647-0485
(918) 647-0571
Mailing address
2706 N BROADWAY ST, POTEAU, OK 74953-5402
(918) 647-0485
(918) 647-0571
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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