Provider Demographics
NPI:1861866840
Name:STOTTS, WILLIAM JASON (MA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JASON
Last Name:STOTTS
Suffix:
Gender:M
Credentials:MA
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 30003
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:ON
Mailing Address - Zip Code:L9B 0E4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 30003
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:ON
Practice Address - Zip Code:L9B 0E4
Practice Address - Country:CA
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty