Provider Demographics
NPI:1508108697
Name:WILLIAMS, TRADIDAS
Entity Type:Individual
Prefix:
First Name:TRADIDAS
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 1:8301 N COUNCIL RD
Mailing Address - Street 2:2110
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4323
Mailing Address - Country:US
Mailing Address - Phone:405-889-1371
Mailing Address - Fax:
Practice Address - Street 1:8301 N COUNCIL RD
Practice Address - Street 2:2110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4323
Practice Address - Country:US
Practice Address - Phone:405-889-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health