Provider Demographics
NPI:1053582510
Name:CONNOR, WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:CONNOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:EDWARD
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12647 OLIVE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6393
Mailing Address - Country:US
Mailing Address - Phone:877-984-8285
Mailing Address - Fax:
Practice Address - Street 1:12647 OLIVE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6393
Practice Address - Country:US
Practice Address - Phone:877-984-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist