Provider Demographics
NPI:1487012456
Name:WILLIAMS, MYAH LE'ANN (BSW, MSW)
Entity Type:Individual
Prefix:
First Name:MYAH
Middle Name:LE'ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4512
Mailing Address - Country:US
Mailing Address - Phone:318-636-4194
Mailing Address - Fax:318-238-3199
Practice Address - Street 1:415 BIENVILLE ST STE 6
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5700
Practice Address - Country:US
Practice Address - Phone:318-652-8140
Practice Address - Fax:318-521-8065
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
LA13092171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker