Healthcare Provider Details

I. General information

NPI: 1225082175
Provider Name (Legal Business Name): JEFF K WILLIAMS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HOSPITAL LOOP STE 350
FAIRCHILD AFB WA
99011-8704
US

IV. Provider business mailing address

701 HOSPITAL LOOP STE 350
FAIRCHILD AFB WA
99011-8704
US

V. Phone/Fax

Practice location:
  • Phone: 208-659-3527
  • Fax:
Mailing address:
  • Phone: 208-659-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-26516
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: