Healthcare Provider Details

I. General information

NPI: 1508404195
Provider Name (Legal Business Name): JEAN BELL WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2019
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 S WESTMORELAND RD
DALLAS TX
75237-2998
US

IV. Provider business mailing address

PO BOX 1715
MANSFIELD TX
76063-0010
US

V. Phone/Fax

Practice location:
  • Phone: 214-632-1575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: