Healthcare Provider Details

I. General information

NPI: 1649015819
Provider Name (Legal Business Name): CLAYTON BRYCE WILLIAMS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N 14TH ST
NEW CASTLE IN
47362-4311
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-2450
  • Fax:
Mailing address:
  • Phone: 765-288-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99124603A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: