Provider Demographics
NPI:1558879775
Name:WILLIAMS, MICHELLE NOEL
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NOEL
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 1:6777 PARK ST E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3828
Mailing Address - Country:US
Mailing Address - Phone:253-329-4969
Mailing Address - Fax:
Practice Address - Street 1:6777 PARK ST E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-3828
Practice Address - Country:US
Practice Address - Phone:253-329-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty