Healthcare Provider Details

I. General information

NPI: 1740475987
Provider Name (Legal Business Name): MARY KILKENNY WILLIAMS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40400 MT VIEW RD
MANCHESTER CA
95459
US

IV. Provider business mailing address

PO BOX 343
POINT ARENA CA
95468-0343
US

V. Phone/Fax

Practice location:
  • Phone: 707-882-2477
  • Fax: 702-882-2477
Mailing address:
  • Phone: 707-882-2477
  • Fax: 707-882-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT22544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: