Provider Demographics
NPI:1487104204
Name:WHITE, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 S SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5759
Mailing Address - Country:US
Mailing Address - Phone:224-406-3798
Mailing Address - Fax:773-723-5091
Practice Address - Street 1:1750 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2821
Practice Address - Country:US
Practice Address - Phone:224-406-3798
Practice Address - Fax:773-723-5091
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 103TA0400X, 103TB0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral