Provider Demographics
NPI:1013578202
Name:WILLIAMS, KIARA MECHERIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIARA
Middle Name:MECHERIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIARA
Other - Middle Name:MECHERIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 MAPLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-1300
Mailing Address - Country:US
Mailing Address - Phone:817-701-8111
Mailing Address - Fax:817-668-6629
Practice Address - Street 1:4455 CAMP BOWIE BLVD STE 114-947
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3864
Practice Address - Country:US
Practice Address - Phone:817-693-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78730101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4051500-01Medicaid