Healthcare Provider Details

I. General information

NPI: 1679166896
Provider Name (Legal Business Name): WILLIAM ROBERT PLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 TX-156 SPUR
WASKOM TX
75692
US

IV. Provider business mailing address

408 CHICO LN
MARSHALL TX
75670-2495
US

V. Phone/Fax

Practice location:
  • Phone: 903-687-2586
  • Fax:
Mailing address:
  • Phone: 903-488-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: