Provider Demographics
NPI:1558492488
Name:WILLIAMS, TELLY DENISE
Entity Type:Individual
Prefix:MISS
First Name:TELLY
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-8300
Mailing Address - Fax:661-868-8317
Practice Address - Street 1:1111 COLUMBUS ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-1936
Practice Address - Country:US
Practice Address - Phone:661-868-8300
Practice Address - Fax:661-868-8317
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator