Provider Demographics
NPI:1740321835
Name:MCWILLIAMS, KURTIS LEIGH (LMFT)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:LEIGH
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-1807
Mailing Address - Country:US
Mailing Address - Phone:209-710-6124
Mailing Address - Fax:209-827-2001
Practice Address - Street 1:635 J ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4224
Practice Address - Country:US
Practice Address - Phone:209-710-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist