Provider Demographics
NPI:1841223336
Name:MIDDENDORF, WILLIAM (MA LPCC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:MIDDENDORF
Suffix:
Gender:M
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 E LOHMAN AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3172
Mailing Address - Country:US
Mailing Address - Phone:575-524-6859
Mailing Address - Fax:575-524-4813
Practice Address - Street 1:1990 E LOHMAN AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-524-6859
Practice Address - Fax:575-524-4813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0069601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health