Healthcare Provider Details

I. General information

NPI: 1750816971
Provider Name (Legal Business Name): JOSHUA WILLIAMS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 POST OAK DR
BRANDON MS
39047-7299
US

IV. Provider business mailing address

129 POST OAK DR
BRANDON MS
39047-7299
US

V. Phone/Fax

Practice location:
  • Phone: 662-836-6235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2099
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: