Provider Demographics
NPI:1457368219
Name:WILLIAMS, JOHN L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:L
Last Name:WILLIAMS
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:PO BOX 40818
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0014
Mailing Address - Country:US
Mailing Address - Phone:512-845-0565
Mailing Address - Fax:512-603-7323
Practice Address - Street 1:7901 CAMERON RD, BLDG 3, STE 337
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754
Practice Address - Country:US
Practice Address - Phone:512-845-0565
Practice Address - Fax:512-693-7323
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166201701Medicaid
TX0073LVOtherBLUECROSS BLUESHIELD
TX0073LVOtherBLUECROSS BLUESHIELD