Provider Demographics
NPI:1053686634
Name:WILLIAMS, KRISTEN RUTH (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RUTH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:WILLIAMS
Other - Last Name:MATHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1801 CRANE RIDGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4902
Mailing Address - Country:US
Mailing Address - Phone:601-573-8642
Mailing Address - Fax:
Practice Address - Street 1:1801 CRANE RIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4902
Practice Address - Country:US
Practice Address - Phone:601-573-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional