Provider Demographics
NPI:1386009843
Name:WILLIAMS, MATISHA (LMFT)
Entity Type:Individual
Prefix:
First Name:MATISHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S RIVER RIDGE CIR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1627
Mailing Address - Country:US
Mailing Address - Phone:612-568-6050
Mailing Address - Fax:
Practice Address - Street 1:190 S RIVER RIDGE CIR
Practice Address - Street 2:SUITE 208
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1627
Practice Address - Country:US
Practice Address - Phone:612-568-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166001003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist