Provider Demographics
NPI:1699040030
Name:WILLIAMS, KENNETH (LPC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WHITE RIVER LN
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-1640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 WHITE RIVER LN
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:MO
Practice Address - Zip Code:63341-1640
Practice Address - Country:US
Practice Address - Phone:636-734-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016628101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional