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General NPI Number Information
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NPI Number | 1295511665
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Entity Type | Organization
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Legal Business Name | RENEE WILLIAMSON BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 2555 55TH PL STE 210
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3550
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Country | US
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Telephone | 317-210-5179
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Fax | 317-251-2403
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Provider Business Mailing Address
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Address Line | PO BOX 88353
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-0353
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Country | US
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Telephone | 317-513-8979
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Fax | 317-251-2403
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. GWENDOLYN RENEE WILLIAMSON
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Credential | LMHC
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Telephone | 317-210-5179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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