Healthcare Provider Details

I. General information

NPI: 1902073448
Provider Name (Legal Business Name): RICHARD R WILLIAMS MA, LPC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 BONFORTE BLVD
PUEBLO CO
81001-1602
US

IV. Provider business mailing address

612 FIELD AVE
CANON CITY CO
81212-2641
US

V. Phone/Fax

Practice location:
  • Phone: 719-404-1996
  • Fax: 719-404-1992
Mailing address:
  • Phone: 719-371-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001138
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0015102
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015102
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: