Healthcare Provider Details

I. General information

NPI: 1447861604
Provider Name (Legal Business Name): WILLIAM A EGUT LCDC III, QMHS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 GEORGETOWN RD STE H-I
HUDSON OH
44236-5013
US

IV. Provider business mailing address

1737 GEORGETOWN RD STE H-I
HUDSON OH
44236-5013
US

V. Phone/Fax

Practice location:
  • Phone: 330-355-9729
  • Fax:
Mailing address:
  • Phone: 330-355-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162903
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: