Healthcare Provider Details

I. General information

NPI: 1215577358
Provider Name (Legal Business Name): ASHLYN WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W MAIN ST STE A
JENKS OK
74037-3525
US

IV. Provider business mailing address

25317 E 62ND ST S
BROKEN ARROW OK
74014-2204
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-9166
  • Fax:
Mailing address:
  • Phone: 918-813-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12064
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: