Healthcare Provider Details

I. General information

NPI: 1255496212
Provider Name (Legal Business Name): DAVID O. WILLIAMS L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 1200 S SUITE # 101
OREM UT
84058-6972
US

IV. Provider business mailing address

3525 RUFFED GROUSE RD
EAGLE MTN UT
84005-4447
US

V. Phone/Fax

Practice location:
  • Phone: 801-836-8678
  • Fax: 801-796-0475
Mailing address:
  • Phone: 801-836-8678
  • Fax: 801-796-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number346397-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: