Provider Demographics
NPI:1962822551
Name:POLLOCK, WILLIAM D
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:POLLOCK
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:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84629-0492
Mailing Address - Country:US
Mailing Address - Phone:435-851-1304
Mailing Address - Fax:435-427-5374
Practice Address - Street 1:22000 N 10380 E
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:UT
Practice Address - Zip Code:84629-0492
Practice Address - Country:US
Practice Address - Phone:435-851-1304
Practice Address - Fax:435-427-5374
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor