Healthcare Provider Details

I. General information

NPI: 1023453529
Provider Name (Legal Business Name): ANDREA LYNN WILLIAMS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5824
US

IV. Provider business mailing address

930 HAMMER ST
HARRISBURG OR
97446-9590
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3608
  • Fax:
Mailing address:
  • Phone: 541-954-3072
  • Fax: 541-995-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3643
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: