Healthcare Provider Details

I. General information

NPI: 1083135636
Provider Name (Legal Business Name): WILLIAM DAVID BACK LPCC, TACDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 CHAMBERLIN AVE STE 2500
FRANKFORT KY
40601-4288
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax: 216-456-8128
Mailing address:
  • Phone: 216-468-5000
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number162868
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number168467
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: