Healthcare Provider Details

I. General information

NPI: 1750801932
Provider Name (Legal Business Name): BRYAN WILLIAMS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 09/11/2025
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44359 PALM ST
INDIO CA
92201-3116
US

IV. Provider business mailing address

77380 MICHIGAN DR
PALM DESERT CA
92211-7928
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-6616
  • Fax:
Mailing address:
  • Phone: 760-673-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW65335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: