Individual
WILLIAM WADE MIDDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT/PET CLINICIAN
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PT26958
CA
167G00000X
Licensed Psychiatric Technician
Primary
PT26958
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245227180
—
CA
01
—
167G00000X
ADDTAXONMY
CA
Enumeration date
06/04/2015
Last updated
08/28/2019
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