Provider Demographics
NPI:1558055970
Name:WILLIAMS, JEFFREY MICHAEL
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 SW BOXELDER ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-4496
Mailing Address - Country:US
Mailing Address - Phone:479-295-7800
Mailing Address - Fax:
Practice Address - Street 1:2106 S 54TH STREET STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8198
Practice Address - Country:US
Practice Address - Phone:479-295-7800
Practice Address - Fax:479-370-5001
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty