=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134563364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN R WILLIAMS M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2013
-----------------------------------------------------
Last Update Date | 04/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 S EUSTIS ST STE E
-----------------------------------------------------
City | EUSTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32726-4886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-368-9154
-----------------------------------------------------
Fax | 321-396-7574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 608896
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32860-8896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-368-9154
-----------------------------------------------------
Fax | 321-396-7574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------