Provider Demographics
NPI:1275522146
Name:PFOHL, WILLIAM (PSYD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PFOHL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 LEHMAN AVE
Mailing Address - Street 2:SUITE 106 BOX 6
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-6502
Mailing Address - Country:US
Mailing Address - Phone:270-782-9996
Mailing Address - Fax:270-796-8973
Practice Address - Street 1:1011 LEHMAN AVE
Practice Address - Street 2:SUITE 106 BOX 6
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6502
Practice Address - Country:US
Practice Address - Phone:270-782-9996
Practice Address - Fax:270-796-8973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY393103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007401Medicare ID - Type Unspecified