MEDICARE: STEPHANIE LYNN WILLIAMS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881381077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN WILLIAMS

Provider Business Mailing Address
First Line	:	5436 W HIGHLAND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1135
Country	:	US
Telephone Number	:	480-364-7270
Fax Number	:

Provider Business Practice Location Address
First Line	:	5436 W HIGHLAND AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85031-1135
Country	:	US
Telephone Number	:	480-364-7270
Fax Number	:

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

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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Directions to “ STEPHANIE LYNN WILLIAMS ” Practice Location

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