MEDICARE: JEANNUEL LEXXY 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	1041C0700X	Clinical Social Worker	149.030819	IL
2	1041C0700X	Clinical Social Worker	110315	TX
3	1041C0700X	Clinical Social Worker	137220	CA

General Provider Information

NPI Number	:	1134788342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNUEL LEXXY WILLIAMS

Provider Business Mailing Address
First Line	:	140 GAITANO DR
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93550-2135
Country	:	US
Telephone Number	:	310-703-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 OLD KATY RD STE 1095
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2128
Country	:	US
Telephone Number	:	832-862-5796
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/04/2026

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