Provider Demographics
NPI:1982976130
Name:WILLIAMS-LEE, TRESSELAR Y (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRESSELAR
Middle Name:Y
Last Name:WILLIAMS-LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-2415
Mailing Address - Country:US
Mailing Address - Phone:318-868-3093
Mailing Address - Fax:318-868-3094
Practice Address - Street 1:3939 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108
Practice Address - Country:US
Practice Address - Phone:318-868-3093
Practice Address - Fax:318-868-3094
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA75471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2304852Medicaid
LA7547OtherSTATE BOARD LICENSE