Provider Demographics
NPI:1548383904
Name:WILLIAMS, JEFFREY WAYNE (LCDC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:WAYNE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:PO BOX 12205
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-2205
Mailing Address - Country:US
Mailing Address - Phone:281-353-8333
Mailing Address - Fax:281-353-8367
Practice Address - Street 1:4405 SPRING CYPRESS RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4400
Practice Address - Country:US
Practice Address - Phone:281-353-8333
Practice Address - Fax:281-353-8367
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX462564OtherVALUE OPTION
TX8513BHOtherBCBS INDIVIDUAL
TX0086JBOtherBCBS GRP