Provider Demographics
NPI:1073579652
Name:RILEY, WILLIAM JOSEPH (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:RILEY
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CARLISLE AVE
Mailing Address - Street 2:SPRINGFIELD
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3503
Mailing Address - Country:US
Mailing Address - Phone:937-398-0014
Mailing Address - Fax:937-398-0022
Practice Address - Street 1:1111 N PLUM ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2154
Practice Address - Country:US
Practice Address - Phone:937-398-0014
Practice Address - Fax:937-398-0022
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965734101YA0400X
OHE2401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional