Provider Demographics
NPI:1083498638
Name:WILLIAMS, TYEISHA
Entity Type:Individual
Prefix:
First Name:TYEISHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4020
Mailing Address - Country:US
Mailing Address - Phone:352-373-4411
Mailing Address - Fax:352-373-4455
Practice Address - Street 1:7443 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8071
Practice Address - Country:US
Practice Address - Phone:352-373-4411
Practice Address - Fax:352-373-4455
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician