Provider Demographics
NPI:1043539182
Name:WILLIAMS, EDWARD P (MED, LADC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MED, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23755 LINDALE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953
Mailing Address - Country:US
Mailing Address - Phone:918-649-0011
Mailing Address - Fax:
Practice Address - Street 1:210 S WILSON ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4917
Practice Address - Country:US
Practice Address - Phone:918-649-0011
Practice Address - Fax:918-649-0066
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation