Provider Demographics
NPI:1114943016
Name:SLAGLE, WILLIAM RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:SLAGLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 WIGWAM PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8177
Mailing Address - Country:US
Mailing Address - Phone:702-454-0201
Mailing Address - Fax:702-454-1245
Practice Address - Street 1:1070 WIGWAM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8178
Practice Address - Country:US
Practice Address - Phone:702-454-0201
Practice Address - Fax:702-454-1245
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002602052Medicaid
NV002602052Medicaid