Healthcare Provider Details

I. General information

NPI: 1093664526
Provider Name (Legal Business Name): WILLIAM W LOREY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E WOODHURST DR STE L100
SPRINGFIELD MO
65804-4260
US

IV. Provider business mailing address

614 SOUTH AVE
SPRINGFIELD MO
65806-3110
US

V. Phone/Fax

Practice location:
  • Phone: 417-616-3736
  • Fax:
Mailing address:
  • Phone: 417-869-9011
  • Fax: 417-889-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026003689
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026003689
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2026003689
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: