Provider Demographics
NPI:1457739427
Name:STAPLETON, WILLIAM MICHAEL II
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:STAPLETON
Suffix:II
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 1:100 E 3RD ST
Mailing Address - Street 2:P.O. BOX 578
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8057
Mailing Address - Country:US
Mailing Address - Phone:740-289-4171
Mailing Address - Fax:740-289-4542
Practice Address - Street 1:100 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8057
Practice Address - Country:US
Practice Address - Phone:740-289-4171
Practice Address - Fax:740-289-4542
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20570769103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool