Provider Demographics
NPI:1902881600
Name:IRVIN, WILLIAM R (M ED, LPCC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:IRVIN
Suffix:
Gender:M
Credentials:M ED, LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22578
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0578
Mailing Address - Country:US
Mailing Address - Phone:502-426-5106
Mailing Address - Fax:603-457-2407
Practice Address - Street 1:7321 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4800
Practice Address - Country:US
Practice Address - Phone:502-426-5106
Practice Address - Fax:603-457-2407
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000072A101YM0800X
KYKY-0017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional