Provider Demographics
NPI:1912112939
Name:MCWILLIAMS, MARTIN RAY (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:RAY
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360
Practice Address - Country:US
Practice Address - Phone:888-403-1071
Practice Address - Fax:660-647-3617
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014000658101YM0800X
GALPC002974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional