Provider Demographics
NPI:1578106837
Name:WILLIAMS, DAMIEN
Entity Type:Individual
Prefix:
First Name:DAMIEN
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 1:2862 E 51ST ST APT H
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-1762
Mailing Address - Country:US
Mailing Address - Phone:929-253-9987
Mailing Address - Fax:
Practice Address - Street 1:300 N DENVER AVE
Practice Address - Street 2:DAVID L. MOSS CRIMINAL JUSTICE CENTER
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-1420
Practice Address - Country:US
Practice Address - Phone:918-596-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator