Healthcare Provider Details

I. General information

NPI: 1487014270
Provider Name (Legal Business Name): RAYMOND WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 CALISTA DRIVE
BETHEL AK
99559-0528
US

IV. Provider business mailing address

PO BOX 528 ATTN:BH-SOBERING CENTER
BETHEL AK
99559-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6830
  • Fax: 907-543-3471
Mailing address:
  • Phone: 907-543-6830
  • Fax: 907-543-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: