Provider Demographics
NPI:1134402068
Name:WILLIAMS, WILLIE BERNARD JR (LPC)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:BERNARD
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 5122
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-5122
Mailing Address - Country:US
Mailing Address - Phone:817-554-3706
Mailing Address - Fax:817-554-3704
Practice Address - Street 1:1733 BRIARCREST DR STE 205
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2755
Practice Address - Country:US
Practice Address - Phone:817-554-3706
Practice Address - Fax:817-554-3704
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2880254Medicaid