Individual
DR. MARY E. WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
(800) 257-8715
(800) 819-1655
Mailing address
1810 JUSTIN LN, AUSTIN, TX 78757-2409
(512) 453-4561
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
24900
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116109302
—
TX
05
—
116109303
—
TX
01
—
86040A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/13/2006
Last updated
07/09/2007
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