Basic Information
| Provider Information | |||||||||
| NPI: | 1356778229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WILLIAM COUTHRAN | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3345 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863142283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285836411 | ||||||||
| FaxNumber: | 9287726430 | ||||||||
| Practice Location | |||||||||
| Address1: | 3345 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863142283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285836411 | ||||||||
| FaxNumber: | 9287726430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2013 | ||||||||
| LastUpdateDate: | 10/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | COUTHRAN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 9285836411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LPC-14205 | AZ | Y | Agencies | Community/Behavioral Health |
No ID Information.