Provider Demographics
NPI:1821975566
Name:WHITE, KELLE CREECY (LCSW-S)
Entity type:Individual
Prefix:
First Name:KELLE
Middle Name:CREECY
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LAKERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:76108-9426
Mailing Address - Country:US
Mailing Address - Phone:817-448-4475
Mailing Address - Fax:
Practice Address - Street 1:108 LAKERIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:TX
Practice Address - Zip Code:76108-9426
Practice Address - Country:US
Practice Address - Phone:817-448-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical