Provider Demographics
NPI:1104832427
Name:AGOR, WILLIAM DAVID (PSYD, LCPC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:AGOR
Suffix:
Gender:M
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1708 SIERRA HIGHLANDS CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5934
Mailing Address - Country:US
Mailing Address - Phone:815-254-7655
Mailing Address - Fax:815-230-3652
Practice Address - Street 1:24402 W LOCKPORT RD
Practice Address - Street 2:UNITR 2B
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-4206
Practice Address - Country:US
Practice Address - Phone:630-621-5824
Practice Address - Fax:815-230-3652
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00022322754OtherBCBS PROVIDER NUMBER