Provider Demographics
NPI:1437801099
Name:WILLIAMS, RANDELL
Entity Type:Individual
Prefix:
First Name:RANDELL
Middle Name:
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 1:43972 W YUCCA LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4019
Mailing Address - Country:US
Mailing Address - Phone:170-741-0951
Mailing Address - Fax:
Practice Address - Street 1:43972 W YUCCA LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4019
Practice Address - Country:US
Practice Address - Phone:707-410-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician