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NPI Code Detail

MEDICARE: MR. GAVIN JOHN WILLIAMS

MEDICARE: MR. GAVIN JOHN WILLIAMS
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
1106H00000XMarriage & Family Therapist67144CA
2106H00000XMarriage & Family Therapist105126CA

General Provider Information

NPI Number : 1013271055
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GAVIN JOHN WILLIAMS
Provider Business Mailing Address
First Line : 1026 FLORIN RD # 289
Second Line :
City : SACRAMENTO
State : CA
Zip : 95831-3513
Country : US
Telephone Number : 916-995-2963
Fax Number : 916-848-0517
Provider Business Practice Location Address
First Line : 1700 EUREKA RD STE 155
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-7786
Country : US
Telephone Number : 916-995-2963
Fax Number : 916-848-0517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2012
Last Update Date : 03/08/2019

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