Provider Demographics
NPI:1295869311
Name:WHITE, TREASA J
Entity type:Individual
Prefix:
First Name:TREASA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TREASA
Other - Middle Name:J
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:300 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8217
Mailing Address - Country:US
Mailing Address - Phone:870-777-9051
Mailing Address - Fax:870-777-3401
Practice Address - Street 1:300 E 20TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8217
Practice Address - Country:US
Practice Address - Phone:870-777-9051
Practice Address - Fax:870-777-3401
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1108062101YP2500X, 101YM0800X
TX63903101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health