Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | IL | |
N | 101YP1600X | Pastoral Counselor | IL | |
N | 101YP2500X | Professional Counselor | IL |
NPI | 1174531867 |
---|---|
Provider Name | Dr. William A Victor |
First Address | Fairfield, IL 62837-2513 |
Second Address | Fairfield, IL 62837-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09622928 | BLUE CROSS BLUE SHIELD IL (01) | |
5593729 | AETNA (01) |