Healthcare Provider Details

I. General information

NPI: 1124567979
Provider Name (Legal Business Name): TAYEKA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 S VALLEY VIEW BLVD STE 1
LAS VEGAS NV
89102-0145
US

IV. Provider business mailing address

2881 S VALLEY VIEW BLVD STE 1
LAS VEGAS NV
89102-0145
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax: 702-922-6600
Mailing address:
  • Phone: 702-922-7015
  • Fax: 702-922-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0013856
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: