MEDICARE: MR. JAMES EDWARD WILLIAMS JR. MS, LPC

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	101YM0800X	Mental Health Counselor	41484	TX
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	41484	TX
3	103TB0200X	Cognitive & Behavioral Psychologist	41484	TX
4	103TP2701X	Group Psychotherapy Psychologist	41484	TX
5	101YP2500X	Professional Counselor	41484	TX

General Provider Information

NPI Number	:	1184215766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EDWARD WILLIAMS JR. MS, LPC

Provider Business Mailing Address
First Line	:	6104 FLAG STONE DR
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-3313
Country	:	US
Telephone Number	:	254-317-0541
Fax Number	:

Provider Business Practice Location Address
First Line	:	6104 FLAG STONE DR
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76542-3313
Country	:	US
Telephone Number	:	254-317-0541
Fax Number	:

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

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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