Individual
JACQUELYN MARIE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCA
Contact information
Practice address
2311 FORTUNE DR STE 201, LEXINGTON, KY 40509-4118
(859) 253-1686
(859) 254-2743
Mailing address
650 S. PEORIA, TULSA, OK 74120-4429
(918) 587-9471
(918) 560-0137
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
101YP2500X
Professional Counselor
0723
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
Enumeration date
04/18/2008
Last updated
06/06/2011
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