Provider Demographics
NPI:1841430675
Name:WILLIAMS, GALEN LESLIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:GALEN
Middle Name:LESLIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COLUMBINE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1326
Mailing Address - Country:US
Mailing Address - Phone:970-812-3888
Mailing Address - Fax:
Practice Address - Street 1:1000 N 9TH ST STE 37
Practice Address - Street 2:SUITE 37
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3153
Practice Address - Country:US
Practice Address - Phone:970-812-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO428171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist