Provider Demographics
NPI:1194340547
Name:HAFER, WILLIAM EVERETT (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EVERETT
Last Name:HAFER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18614 JACKSON STREET
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668
Mailing Address - Country:US
Mailing Address - Phone:417-745-2121
Mailing Address - Fax:417-745-0056
Practice Address - Street 1:1100 SOUTH SPRINGFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-326-7272
Practice Address - Fax:714-326-2193
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160416911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical