Individual
MOLLIE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S 11TH AVE STE 204, POCATELLO, ID 83201-4878
(208) 232-7862
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1461876
ID
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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