Healthcare Provider Details

I. General information

NPI: 1932643715
Provider Name (Legal Business Name): JENNIFER MARIE WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S 8TH ST
MURRAY KY
42071-2428
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 270-753-2395
  • Fax: 270-759-4745
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255612
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: