Provider Demographics
NPI:1932393139
Name:OLDHAM, WILLIAM D (LPC, MDIV)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:OLDHAM
Suffix:
Gender:M
Credentials:LPC, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 SE G ST STE 9
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3742
Mailing Address - Country:US
Mailing Address - Phone:479-855-5704
Mailing Address - Fax:
Practice Address - Street 1:701 N WALTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4548
Practice Address - Country:US
Practice Address - Phone:479-855-5704
Practice Address - Fax:479-268-4170
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0407033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X971OtherBCBS