MEDICARE: MARY ANN WILLIAMSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	001837	MO

General Provider Information

NPI Number	:	1003130865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN WILLIAMSON

Provider Business Mailing Address
First Line	:	9735 LANDMARK PARKWAY DR
Second Line	:	SUITE 17
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1646
Country	:	US
Telephone Number	:	314-842-6223
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 BONHOMME AVE
Second Line	:	SUITE 909
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1911
Country	:	US
Telephone Number	:	800-356-0845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	03/23/2010

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