Provider Demographics
NPI:1770740748
Name:WILLIAMS, JAMES DAVID (MS LPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS LPC
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 948
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-0948
Mailing Address - Country:US
Mailing Address - Phone:918-453-5523
Mailing Address - Fax:918-458-0499
Practice Address - Street 1:17091 S MUSKOGEE
Practice Address - Street 2:BUILDING 4
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-453-5523
Practice Address - Fax:918-458-0499
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional