Provider Demographics
NPI:1235364357
Name:KRILL, WILLIAM EDWIN JR (LPC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWIN
Last Name:KRILL
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4031
Mailing Address - Country:US
Mailing Address - Phone:814-932-7078
Mailing Address - Fax:
Practice Address - Street 1:521 E 25TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4031
Practice Address - Country:US
Practice Address - Phone:814-932-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024701610002Medicaid