Provider Demographics
NPI:1245566983
Name:MOELLER, WILLIAM PETER (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:MOELLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CRESCENT BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4539
Mailing Address - Country:US
Mailing Address - Phone:630-545-0610
Mailing Address - Fax:630-545-0640
Practice Address - Street 1:505 CRESCENT BLVD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4539
Practice Address - Country:US
Practice Address - Phone:630-545-0610
Practice Address - Fax:630-545-0640
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10790104100000X
IL150012593104100000X
IL1490149631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker