Healthcare Provider Details

I. General information

NPI: 1124205216
Provider Name (Legal Business Name): LISA CAMERON WILLIAMS ATR, LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 S EAGLE RD
MERIDIAN ID
83642-6707
US

IV. Provider business mailing address

1515 N 27TH ST
BOISE ID
83702-0114
US

V. Phone/Fax

Practice location:
  • Phone: 208-955-7733
  • Fax: 208-955-7330
Mailing address:
  • Phone: 208-484-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-4001
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: