Provider Demographics
NPI:1598095937
Name:DEFOORE, WILLIAM G (LPC, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:DEFOORE
Suffix:
Gender:M
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14675 MIDWAY RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3170
Mailing Address - Country:US
Mailing Address - Phone:214-764-7930
Mailing Address - Fax:214-764-7931
Practice Address - Street 1:14675 MIDWAY RD
Practice Address - Street 2:SUITE 116
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3170
Practice Address - Country:US
Practice Address - Phone:214-764-7930
Practice Address - Fax:214-764-7931
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3317101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist