Provider Demographics
NPI:1669592812
Name:WILLIAMS, JAYNE H (LPCC)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:H
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 E TOWNSHIP ROAD 130
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-9680
Mailing Address - Country:US
Mailing Address - Phone:419-447-6364
Mailing Address - Fax:
Practice Address - Street 1:715 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3200
Practice Address - Country:US
Practice Address - Phone:419-334-6619
Practice Address - Fax:419-334-6671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE0900056OtherLICENSE