Provider Demographics
NPI:1447524566
Name:WHITE, ALISHA N (BHRS)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-0091
Mailing Address - Country:US
Mailing Address - Phone:580-618-2911
Mailing Address - Fax:
Practice Address - Street 1:121 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-1973
Practice Address - Country:US
Practice Address - Phone:580-369-5080
Practice Address - Fax:580-369-2488
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040ZMedicaid