Provider Demographics
NPI:1598065807
Name:WILLIAMS, MARK A (CADC III/LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CADC III/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1482
Mailing Address - Country:US
Mailing Address - Phone:541-447-2631
Mailing Address - Fax:
Practice Address - Street 1:548 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3184
Practice Address - Country:US
Practice Address - Phone:541-388-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-06-113101YA0400X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500738403Medicaid
OR500738399Medicaid
ORC7120OtherOREGON LPC LISC.