Healthcare Provider Details

I. General information

NPI: 1033205703
Provider Name (Legal Business Name): WILLIAM SPEARS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 OAK HAVEN RD
PURVIS MS
39475-3408
US

IV. Provider business mailing address

54 OAK HAVEN RD
PURVIS MS
39475-3408
US

V. Phone/Fax

Practice location:
  • Phone: 601-261-9918
  • Fax: 601-261-9918
Mailing address:
  • Phone: 601-261-9918
  • Fax: 601-261-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number889
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: