Provider Demographics
NPI:1932112315
Name:MCWILLIAMS, PAUL IAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:IAN
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20412 BRIAN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8702
Mailing Address - Country:US
Mailing Address - Phone:661-823-0661
Mailing Address - Fax:661-823-8474
Practice Address - Street 1:20412 BRIAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8702
Practice Address - Country:US
Practice Address - Phone:661-823-0661
Practice Address - Fax:661-823-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13828ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER