Provider Demographics
NPI:1861518813
Name:BURRICHTER, WILLIAM R (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:BURRICHTER
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S ANGLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-2031
Mailing Address - Country:US
Mailing Address - Phone:171-653-1507
Mailing Address - Fax:717-653-1527
Practice Address - Street 1:410 S ANGLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-2031
Practice Address - Country:US
Practice Address - Phone:171-653-1507
Practice Address - Fax:717-653-1527
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001569101YP2500X
PA01010377101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
11878767OtherCAQH