Provider Demographics
NPI:1134563364
Name:WILLIAMS, BRIAN R (MS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS
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 608896
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-8896
Mailing Address - Country:US
Mailing Address - Phone:813-368-9154
Mailing Address - Fax:321-396-7574
Practice Address - Street 1:800 S EUSTIS ST STE E
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4886
Practice Address - Country:US
Practice Address - Phone:813-368-9154
Practice Address - Fax:321-396-7574
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist