Derrick White, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P1905056 Issued in AR

Practice address

855 S German LN Ste 1
Conway, AR 72034-6479

Phone

(501) 358-6606

Fax

(501) 491-0039

NPI assigned

May 4, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Conway Counseling and Psychological Services PLLCGroup PAC ID 4183933781, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Conway Counseling & Psychological Services, PLLC

  • Professional Counselor
  • Conway, AR
  • NPI 1528454139
  Medicare reassignment Care Compare group NPD
• Ideal Counseling PLLC

  • Professional Counselor
  • Conway, AR
  • NPI 1356144901
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1124474556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 S SALEM RD APT 3",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348565",
            "telephone_number": "501-908-7448",
            "fax_number": "501-204-8612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 S GERMAN LN STE 1",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346479",
            "telephone_number": "501-358-6606",
            "fax_number": "501-491-0039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1422 Caldwell St Ste I",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "AR",
            "postal_code": "720345319",
            "country_code": "US",
            "telephone_number": "501-908-7448",
            "fax_number": "501-204-8612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "DERRICK",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-04",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1905056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ella Cathrine Whaley, M.D.
• Amber Whatley, APRN
• Whitney Whillock
• Amy White, RN
• Darrelle White, RECOVERY ASSISTANT
• Doris White, CARE COORDINATOR
• Heather A White, A.P.N.
• Jeffrey Cade White
• Jordan Hunter White, M.D.
• Lance Kyle White, LPC

• Professional Counselor in Conway, AR
• Providers in Conway, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.