Provider Demographics
NPI:1780857615
Name:SLUYTER, WILLIAM ALLEN
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALLEN
Last Name:SLUYTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 N GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-7760
Mailing Address - Country:US
Mailing Address - Phone:575-627-0147
Mailing Address - Fax:575-622-8506
Practice Address - Street 1:3115 N GARDEN AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-7760
Practice Address - Country:US
Practice Address - Phone:575-627-0147
Practice Address - Fax:575-622-8506
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0111911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health