Provider Demographics
NPI:1467685271
Name:BERHORST, BILLY JOE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:BERHORST
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:BERHORST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:14 JAN MAR DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MO
Mailing Address - Zip Code:63435-1201
Mailing Address - Country:US
Mailing Address - Phone:174-309-6712
Mailing Address - Fax:
Practice Address - Street 1:14 JAN MAR DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MO
Practice Address - Zip Code:63435-1201
Practice Address - Country:US
Practice Address - Phone:217-430-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060251601041C0700X
IA0078741041C0700X
IL1490119401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL634650061Medicare PIN