Provider Demographics
NPI:1871302802
Name:WHITE, JASON MONDALE (LPC-A)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MONDALE
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 SUNDANCE PL
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5027
Mailing Address - Country:US
Mailing Address - Phone:808-294-1073
Mailing Address - Fax:
Practice Address - Street 1:5800 SUNDANCE PL
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5027
Practice Address - Country:US
Practice Address - Phone:808-294-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64315101YA0400X
TX96682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)