Provider Demographics
NPI:1760806996
Name:RILEY, WILLIAM TOBIAS (LPC-S)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TOBIAS
Last Name:RILEY
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 KEYWOOD CIR STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3001
Mailing Address - Country:US
Mailing Address - Phone:601-397-0070
Mailing Address - Fax:601-397-0252
Practice Address - Street 1:499 KEYWOOD CIR STE A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3001
Practice Address - Country:US
Practice Address - Phone:601-397-0070
Practice Address - Fax:601-397-0252
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1601101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02721069Medicaid