Provider Demographics
NPI:1508570946
Name:SANTOS, WILLIAM HUNTER (LAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HUNTER
Last Name:SANTOS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18250 N 25TH AVE APT 2063
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1279
Mailing Address - Country:US
Mailing Address - Phone:347-303-1425
Mailing Address - Fax:
Practice Address - Street 1:2131 E BROADWAY RD STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1737
Practice Address - Country:US
Practice Address - Phone:480-525-0058
Practice Address - Fax:480-684-3060
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional