MEDICARE: LYDIA LEE WILLIAMS MASTERS COUNSELING

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083950059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA LEE WILLIAMS MASTERS COUNSELING

Provider Business Mailing Address
First Line	:	2610 RICHLAND ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6114
Country	:	US
Telephone Number	:	858-212-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 CONGRESS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2757
Country	:	US
Telephone Number	:	619-688-1035
Fax Number	:	619-688-1098

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

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	12/19/2012

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