Provider Demographics
NPI:1942521950
Name:WILLIAMS, WILLIE LEE JR (BS)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:LEE
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 SPRUCE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-8924
Mailing Address - Country:US
Mailing Address - Phone:405-990-0549
Mailing Address - Fax:405-455-7122
Practice Address - Street 1:7901 NE 10TH ST
Practice Address - Street 2:C116
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3600
Practice Address - Country:US
Practice Address - Phone:405-455-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK080516929101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor