Provider Demographics
NPI:1275189821
Name:SCRUGGS, WILLIAM ESTES (LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ESTES
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAMMOCK TRL E APT F203
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-7672
Mailing Address - Country:US
Mailing Address - Phone:601-497-2806
Mailing Address - Fax:
Practice Address - Street 1:205 HAMMOCK TRL E APT F203
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-7672
Practice Address - Country:US
Practice Address - Phone:601-497-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2524OtherSOCIAL SECURITY