Healthcare Provider Details

I. General information

NPI: 1831786045
Provider Name (Legal Business Name): RAY WILLIAMS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6542 REGENCY LN STE 101
EDEN PRAIRIE MN
55344-7847
US

IV. Provider business mailing address

6542 REGENCY LN STE 101
EDEN PRAIRIE MN
55344-7847
US

V. Phone/Fax

Practice location:
  • Phone: 952-314-9556
  • Fax:
Mailing address:
  • Phone: 952-314-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND THOMAS WILLIAMS
Title or Position: PRESIDENT, OWNER
Credential: LMFT
Phone: 952-314-9556