Individual
DR. BLAKE F WHITE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5623 BOSQUE VISTA DR NE, ALBUQUERQUE, NM 87111-8067
(505) 917-3862
Mailing address
5623 BOSQUE VISTA DR NE, ALBUQUERQUE, NM 87111-8067
(505) 917-3862
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
213
NM
103TP0016X
Prescribing (Medical) Psychologist
Primary
0033
NM
Other
Enumeration date
03/15/2007
Last updated
03/31/2014
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