Provider Demographics
NPI:1447861604
Name:EGUT, WILLIAM A (CDCA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:EGUT
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6694 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9201
Mailing Address - Country:US
Mailing Address - Phone:216-785-8628
Mailing Address - Fax:
Practice Address - Street 1:6694 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OH
Practice Address - Zip Code:44216-9201
Practice Address - Country:US
Practice Address - Phone:216-785-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174285101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)