Provider Demographics
NPI:1225082175
Name:WILLIAMS, JEFF K (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 W MILL AVE
Mailing Address - Street 2:# 205
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2489
Mailing Address - Country:US
Mailing Address - Phone:208-659-3527
Mailing Address - Fax:208-292-4544
Practice Address - Street 1:1042 W MILL AVE
Practice Address - Street 2:# 205
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2489
Practice Address - Country:US
Practice Address - Phone:208-659-3527
Practice Address - Fax:208-292-4544
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-265161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical