Provider Demographics
NPI:1871511857
Name:DEGROOT III, WILLIAM ALFRED (MFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALFRED
Last Name:DEGROOT III
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 FRASER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5632
Mailing Address - Country:US
Mailing Address - Phone:951-733-4217
Mailing Address - Fax:951-737-6257
Practice Address - Street 1:1901 WEST ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5632
Practice Address - Country:US
Practice Address - Phone:951-733-4217
Practice Address - Fax:951-737-6257
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMF18816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist