Healthcare Provider Details

I. General information

NPI: 1487233763
Provider Name (Legal Business Name): WILLIAM NESMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 S TACOMA WAY
LAKEWOOD WA
98499-4456
US

IV. Provider business mailing address

15 OREGON AVE STE 308
TACOMA WA
98409-7462
US

V. Phone/Fax

Practice location:
  • Phone: 253-503-3666
  • Fax:
Mailing address:
  • Phone: 253-304-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: