Healthcare Provider Details

I. General information

NPI: 1740961176
Provider Name (Legal Business Name): MYA WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYA WYATT

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 BROADWAY ST APT D
INDIANAPOLIS IN
46202-5007
US

IV. Provider business mailing address

1927 BROADWAY ST APT D
INDIANAPOLIS IN
46202-5007
US

V. Phone/Fax

Practice location:
  • Phone: 317-690-3146
  • Fax:
Mailing address:
  • Phone: 317-690-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113156
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009289A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: