Provider Demographics
NPI:1659410686
Name:WILLIAMS, JAMES LEE
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:LEE
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:678 S FAWN ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-7019
Mailing Address - Country:US
Mailing Address - Phone:971-386-3443
Mailing Address - Fax:
Practice Address - Street 1:247 SE WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4169
Practice Address - Country:US
Practice Address - Phone:971-386-3443
Practice Address - Fax:503-648-0755
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR11-CRM-134175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator