Provider Demographics
NPI:1679557094
Name:WILLIAMS, JANICE LOU (LPC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LOU
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:LOU
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 607
Mailing Address - Street 2:212 NORTH MAIN,
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772
Mailing Address - Country:US
Mailing Address - Phone:417-667-9608
Mailing Address - Fax:417-667-9713
Practice Address - Street 1:212 NORTH MAIN,
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772
Practice Address - Country:US
Practice Address - Phone:417-667-9608
Practice Address - Fax:417-667-9713
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000155573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1679557094Medicaid
MO494709405Medicaid