Provider Demographics
NPI:1912030552
Name:GROVES, WILLIAM JOESPH (LADC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOESPH
Last Name:GROVES
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W HIGHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-1530
Mailing Address - Country:US
Mailing Address - Phone:405-377-1517
Mailing Address - Fax:405-377-2988
Practice Address - Street 1:608 W HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-1530
Practice Address - Country:US
Practice Address - Phone:405-377-1517
Practice Address - Fax:405-377-2988
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)