Provider Demographics
NPI:1760023089
Name:WILLIAMS, RISA (LMFT, MFA, MA)
Entity Type:Individual
Prefix:MRS
First Name:RISA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMFT, MFA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W OLYMPIC BLVD STE 704
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1439
Mailing Address - Country:US
Mailing Address - Phone:310-712-3411
Mailing Address - Fax:
Practice Address - Street 1:714 W OLYMPIC BLVD STE 704
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1439
Practice Address - Country:US
Practice Address - Phone:310-712-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist