Provider Demographics
NPI:1750466272
Name:BOX, WILLIAM RALPH (MDIV, MS, LPCC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RALPH
Last Name:BOX
Suffix:
Gender:M
Credentials:MDIV, MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 BRANT RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-9734
Mailing Address - Country:US
Mailing Address - Phone:937-681-3177
Mailing Address - Fax:
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-7520
Practice Address - Country:US
Practice Address - Phone:937-681-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0002272 SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH267576000OtherMAGELLAN
OH000000223368OtherANTHEM
OH6231302OtherUNITED BEHAVIORAL HEALTH