Provider Demographics
NPI:1326730391
Name:WILLIAMS, BENJAMIN MICHEAL
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHEAL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E 1000 N APT P2
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-2581
Mailing Address - Country:US
Mailing Address - Phone:385-326-5757
Mailing Address - Fax:
Practice Address - Street 1:1392 W TURF FARM WAY STE 1-153
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5587
Practice Address - Country:US
Practice Address - Phone:385-326-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician