Healthcare Provider Details

I. General information

NPI: 1619237112
Provider Name (Legal Business Name): JAYSON ALAN WILLIAMS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E LAFAYETTE AVE
COALGATE OK
74538-2676
US

IV. Provider business mailing address

PO BOX 31
LEHIGH OK
74556-0031
US

V. Phone/Fax

Practice location:
  • Phone: 580-927-3168
  • Fax:
Mailing address:
  • Phone: 580-509-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: