Provider Demographics
NPI:1538830815
Name:WHITE, ROBERT LEE (LPC-A, LCDC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:LPC-A, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 BROADLEAF DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-2333
Mailing Address - Country:US
Mailing Address - Phone:409-201-1667
Mailing Address - Fax:409-899-5309
Practice Address - Street 1:6820 BROADLEAF DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-2333
Practice Address - Country:US
Practice Address - Phone:409-201-1667
Practice Address - Fax:409-899-5309
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14059101YA0400X
TX85456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)