Provider Demographics
NPI:1407422678
Name:WILLIAMS, BRANDON MALIK
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MALIK
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 1:2590 LAKEVIEW DR APT 4
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4551
Mailing Address - Country:US
Mailing Address - Phone:541-515-0997
Mailing Address - Fax:
Practice Address - Street 1:2590 LAKEVIEW DR APT 4
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-4551
Practice Address - Country:US
Practice Address - Phone:541-515-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10214211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst