1265875124 NPI number — DR. SAMANTHA NICOLE WHITE PSY.D.

Table of content: DR. SAMANTHA NICOLE WHITE PSY.D. (NPI 1265875124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265875124 NPI number — DR. SAMANTHA NICOLE WHITE PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
SAMANTHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265875124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 SWINGLE BUILDING
Provider Second Line Business Mailing Address:
MONTANA STATE UNIVERSITY
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59717-3180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-994-4531
Provider Business Mailing Address Fax Number:
406-994-2485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 SWINGLE BUILDING
Provider Second Line Business Practice Location Address:
MONTANA STATE UNIVERSITY
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59717-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-994-4531
Provider Business Practice Location Address Fax Number:
406-994-2485
Provider Enumeration Date:
04/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  949 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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