Healthcare Provider Details

I. General information

NPI: 1023751468
Provider Name (Legal Business Name): MS. TIFFANY THADENA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 N MILLBROOK AVE
FRESNO CA
93710-5620
US

IV. Provider business mailing address

6376 N 10TH ST
FRESNO CA
93710-5728
US

V. Phone/Fax

Practice location:
  • Phone: 559-252-6844
  • Fax:
Mailing address:
  • Phone: 559-421-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: