Provider Demographics
NPI:1225325442
Name:WILLIAM A. VICTOR
Entity Type:Organization
Organization Name:WILLIAM A. VICTOR
Other - Org Name:THE MIDWEST RELATIONSHIP CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LCPC
Authorized Official - Phone:618-516-3337
Mailing Address - Street 1:4109 BASSEN DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7909
Mailing Address - Country:US
Mailing Address - Phone:618-516-3337
Mailing Address - Fax:618-233-7935
Practice Address - Street 1:6 EMERALD TER
Practice Address - Street 2:SUITE 4
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2312
Practice Address - Country:US
Practice Address - Phone:618-233-0500
Practice Address - Fax:618-233-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113166OtherHEALTH ALLIANCE
IL027568OtherVMC BEHAVIORIL HEALTHCARE SERVICES
IL09622928OtherBLUE CROSS BLUE SHIELD IL
5281OtherCURALINC HEALTHCARE
IL5593729OtherAETNA
IL11759843OtherCAQH
IL395768OtherHEALTHLINK
IL436317OtherMANAGED HEALTH NETWORK
IL2195725OtherCOMPSYCH
IL400540OtherVAULE OPTIONS