Active NPI
Michelle Sarah White, PSY.D.
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1639306988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071007672
- Practice address
- 4801 W Peterson Ave
Suite 303
Chicago, IL 60646-5713 - Phone
- (773) 282-2322
- Fax
- (773) 282-2853
- NPI assigned
- Jun 14, 2009
- Last updated
- Jun 14, 2009
- Sex
- Female
- Sole proprietor
- No
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 | 071007672 | IL | Primary |
Addresses
Primary practice location
4801 W Peterson Ave
Suite 303
Chicago, IL 60646-5713
Mailing address
4801 W Peterson Ave
Suite 303
Chicago, IL 60646-5713
Phone (773) 315-1715
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 |
|---|---|---|---|
| 071007672 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jennifer Davis and Michelle S. White | Clinical | Past | Accepting new patients |
| Family Adolescent Child Treatment Service LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychologist
- Chicago, IL
- NPI 1578839700
-
dba Family Adolescent Child Treatment Service, LLC
- Clinical Psychologist
- Chicago, IL
- NPI 1295321677
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244937600000",
"number": "1639306988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 W PETERSON AVE",
"address_2": "SUITE 303",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606465713",
"telephone_number": "773-315-1715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 W PETERSON AVE",
"address_2": "SUITE 303",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606465713",
"telephone_number": "773-282-2322",
"fax_number": "773-282-2853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "MICHELLE",
"middle_name": "SARAH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-14",
"last_updated": "2009-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071007672",
"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 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.