Active NPI
Grant White III, PSY.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1134481658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071-005123
- Practice address
- 222 Merchandise Mart PLZ
Suite 13-659 Room #1352
Chicago, IL 60654-1103 - Phone
- (708) 207-8074
- Fax
- (708) 679-0015
- NPI assigned
- Jun 11, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071-005123 | IL | Primary |
Addresses
Primary practice location
222 Merchandise Mart PLZ
Suite 13-659 Room #1352
Chicago, IL 60654-1103
Mailing address
23002 Amber LN
Richton Park, IL 60471-1282
Phone (708) 503-9880
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-005123 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339372800000",
"number": "1134481658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23002 AMBER LN",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711282",
"telephone_number": "708-503-9880",
"fax_number": "708-679-0015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 MERCHANDISE MART PLZ",
"address_2": "SUITE 13-659 ROOM #1352",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606541103",
"telephone_number": "708-207-8074",
"fax_number": "708-679-0015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "GRANT",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-11",
"last_updated": "2012-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071-005123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.