Healthcare Provider Details

I. General information

NPI: 1174946404
Provider Name (Legal Business Name): ANTHONY D WILLIAMS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10672 PENDLETON ST
RIVERSIDE CA
92505-1740
US

IV. Provider business mailing address

1215 W 84TH PL
LOS ANGELES CA
90044-2213
US

V. Phone/Fax

Practice location:
  • Phone: 323-708-0161
  • Fax:
Mailing address:
  • Phone: 323-708-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129315
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT129315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: