MEDICARE: MR. WILLIAM MIDDENDORF MA LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0069601	NM

General Provider Information

NPI Number	:	1841223336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MIDDENDORF MA LPCC

Provider Business Mailing Address
First Line	:	1990 E LOHMAN AVE
Second Line	:	SUITE 119
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	575-524-6859
Fax Number	:	575-524-4813

Provider Business Practice Location Address
First Line	:	1990 E LOHMAN AVE
Second Line	:	SUITE 119
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3172
Country	:	US
Telephone Number	:	575-524-6859
Fax Number	:	575-524-4813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/19/2009

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