Provider Demographics
NPI:1265013114
Name:WHITE, CHANDRE LYNN (RBT)
Entity type:Individual
Prefix:
First Name:CHANDRE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CHANDRE
Other - Middle Name:LYNN
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4721 S CLIFF AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6969
Mailing Address - Country:US
Mailing Address - Phone:816-608-1956
Mailing Address - Fax:800-687-5070
Practice Address - Street 1:338 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7367
Practice Address - Country:US
Practice Address - Phone:573-708-7250
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-21-152053106S00000X
RBT-24-346573106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician