Healthcare Provider Details

I. General information

NPI: 1275522146
Provider Name (Legal Business Name): WILLIAM PFOHL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 LEHMAN AVE SUITE 106 BOX 6
BOWLING GREEN KY
42103-6502
US

IV. Provider business mailing address

1011 LEHMAN AVE SUITE 106 BOX 6
BOWLING GREEN KY
42103-6502
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-9996
  • Fax: 270-796-8973
Mailing address:
  • Phone: 270-782-9996
  • Fax: 270-796-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number393
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: