Provider Demographics
NPI:1962614701
Name:ATHERTON, WILLIAM R (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:ATHERTON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1269
Mailing Address - Country:US
Mailing Address - Phone:660-248-3933
Mailing Address - Fax:
Practice Address - Street 1:9501 W COYOTE HILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:MO
Practice Address - Zip Code:65256-9598
Practice Address - Country:US
Practice Address - Phone:573-874-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050184831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical