Provider Demographics
NPI:1609166289
Name:WILLIAMS, JIM O (MA)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S GRADY WAY
Mailing Address - Street 2:EVERGREEN BLDG. - SUITE LL24
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3220
Mailing Address - Country:US
Mailing Address - Phone:425-306-6703
Mailing Address - Fax:
Practice Address - Street 1:15 S GRADY WAY
Practice Address - Street 2:EVERGREEN BLDG. - SUITE LL24
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3220
Practice Address - Country:US
Practice Address - Phone:425-306-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60155945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health