Provider Demographics
NPI:1437146867
Name:DONNELLY, WILLIAM O (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:O
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DONNELLY COMMUNITY PSYCHOLOGY
Mailing Address - Street 2:429 W. COLLEGE AVENUE, PO BOX 105
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-0105
Mailing Address - Country:US
Mailing Address - Phone:419-972-1211
Mailing Address - Fax:
Practice Address - Street 1:429 W. COLLEGE AVE
Practice Address - Street 2:DONNELLY COMMUNITY PSYCHOLOGY
Practice Address - City:PEMBERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43450
Practice Address - Country:US
Practice Address - Phone:419-972-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical