Provider Demographics
NPI:1467927616
Name:WILLIAMS, KATHRYN RENEE (MM, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MM, MT-BC
Mailing Address - Street 1:916 SILVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6125
Mailing Address - Country:US
Mailing Address - Phone:817-597-5152
Mailing Address - Fax:
Practice Address - Street 1:916 SILVERSTONE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6125
Practice Address - Country:US
Practice Address - Phone:817-597-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12152225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist