Healthcare Provider Details

I. General information

NPI: 1548768914
Provider Name (Legal Business Name): ELIZABETH WILLIAMS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE 311-G
GLENDALE AZ
85308-8725
US

IV. Provider business mailing address

13324 W OCOTILLO LN
SURPRISE AZ
85374-5255
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-2029
  • Fax:
Mailing address:
  • Phone: 517-755-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-16026
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: