Healthcare Provider Details

I. General information

NPI: 1245422575
Provider Name (Legal Business Name): MR. ANDREW L WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 DURFEE AVE MENTAL HEALTH PMRT
EL MONTE CA
91732-2510
US

IV. Provider business mailing address

1160 N CONWELL AVE APT 226
COVINA CA
91722-1375
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-2004
  • Fax: 626-455-0623
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: