MEDICARE: BRIAN NATHANIEL WILLIAMS CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11663739-3502	UT

General Provider Information

NPI Number	:	1598548091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN NATHANIEL WILLIAMS CSW

Provider Business Mailing Address
First Line	:	925 S WEST TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 S WEST TEMPLE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2928
Country	:	US
Telephone Number	:	801-799-3103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/17/2023

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