Provider Demographics
NPI:1902857055
Name:WILLIAMS, BRUCE DOUGLAS (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 1ST AVE NE
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3160
Mailing Address - Country:US
Mailing Address - Phone:319-362-3149
Mailing Address - Fax:
Practice Address - Street 1:4080 1ST AVE NE
Practice Address - Street 2:SUITE 102A
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3160
Practice Address - Country:US
Practice Address - Phone:319-362-3149
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health