Provider Demographics
NPI:1134676539
Name:MOULTON, WILLIAM A III (MA MAED)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:MOULTON
Suffix:III
Gender:M
Credentials:MA MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8280 COLLEGE PKWY
Mailing Address - Street 2:STE 103
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4103
Mailing Address - Country:US
Mailing Address - Phone:239-224-2305
Mailing Address - Fax:
Practice Address - Street 1:8280 COLLEGE PKWY
Practice Address - Street 2:STE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4103
Practice Address - Country:US
Practice Address - Phone:239-224-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health