Provider Demographics
NPI:1790026490
Name:UTLEY, WILLIAM G (LCSW, CADCII, CPS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:UTLEY
Suffix:
Gender:M
Credentials:LCSW, CADCII, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0395
Mailing Address - Country:US
Mailing Address - Phone:541-891-4533
Mailing Address - Fax:
Practice Address - Street 1:2821 DAGGETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1130
Practice Address - Country:US
Practice Address - Phone:541-274-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
ORL77551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1114058898Medicaid
OR1720105489Medicaid