Provider Demographics
NPI:1720409329
Name:WILLIAMS, JASON R (LMFT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 MADELINE DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8221
Mailing Address - Country:US
Mailing Address - Phone:559-469-7512
Mailing Address - Fax:
Practice Address - Street 1:1393 BAILEY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5922
Practice Address - Country:US
Practice Address - Phone:559-639-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAIMF80378106H00000X
CAMFC121679106H00000X
LMFT121679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist