Provider Demographics
NPI:1497032940
Name:WILLIAMS, CLINT (MHPP)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ROCKINGCHAIR RD STE 1-3
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2413
Mailing Address - Country:US
Mailing Address - Phone:870-335-9617
Mailing Address - Fax:870-335-9618
Practice Address - Street 1:100 N ROCKINGCHAIR RD STE 1-3
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2413
Practice Address - Country:US
Practice Address - Phone:870-335-9617
Practice Address - Fax:870-335-9618
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator