Provider Demographics
NPI:1427119916
Name:AUTREY, WILLIAM STANLEY X
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STANLEY
Last Name:AUTREY
Suffix:X
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 TORO ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3329
Mailing Address - Country:US
Mailing Address - Phone:805-781-4190
Mailing Address - Fax:805-781-4189
Practice Address - Street 1:1103 TORO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3329
Practice Address - Country:US
Practice Address - Phone:805-781-4190
Practice Address - Fax:805-781-4189
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6216103T00000X
CAPSY6216103TB0200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic