=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023697364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JODY WILLIAMS, LCSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2021
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3320 N BUFFALO DR STE 207
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89129-7411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-720-2565
-----------------------------------------------------
Fax | 702-552-5163
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 753762
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89136-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-720-2565
-----------------------------------------------------
Fax | 702-665-5876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JODY WILLIAMS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 702-720-2565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------