Provider Demographics
NPI:1881853174
Name:WILLIAMS, WALTER KEITH JR (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:KEITH
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7881
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-0000
Mailing Address - Country:US
Mailing Address - Phone:337-532-5589
Mailing Address - Fax:
Practice Address - Street 1:3940 HOLLY HILL RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2531
Practice Address - Country:US
Practice Address - Phone:337-532-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2502101YM0800X
LA266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist