Provider Demographics
NPI:1912425737
Name:WILLIAMS, AMBER RENE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 LAURIE RD E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2629
Mailing Address - Country:US
Mailing Address - Phone:715-828-2762
Mailing Address - Fax:
Practice Address - Street 1:1875 NORTHWESTERN AVE S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7534
Practice Address - Country:US
Practice Address - Phone:651-439-4840
Practice Address - Fax:651-439-4894
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional