Provider Demographics
NPI:1194736397
Name:ROOK, WILLIAM CARL (MA, LCPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARL
Last Name:ROOK
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 SAINT NICHOLAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-531-8501
Mailing Address - Fax:
Practice Address - Street 1:732 SUSSEX WAY
Practice Address - Street 2:SUITE B
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3074
Practice Address - Country:US
Practice Address - Phone:618-531-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08232032Medicare UPIN
IL473235Medicare UPIN
IL93478Medicare UPIN
IL399017Medicare UPIN