MEDICARE: MRS. PATRICIA ANN 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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1073711867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN WILLIAMS

Provider Business Mailing Address
First Line	:	2710 W 76TH ST
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-1003
Country	:	US
Telephone Number	:	323-778-0566
Fax Number	:	323-778-0547

Provider Business Practice Location Address
First Line	:	4920 AVALON BLVD
Second Line	:	BAART
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-4004
Country	:	US
Telephone Number	:	323-235-5035
Fax Number	:	323-235-2023

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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