MEDICARE: EBONY STAR WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician	TX
2	247200000X	Other Technician
3	171M00000X	Case Manager/Care Coordinator	TX

General Provider Information

NPI Number	:	1235619198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY STAR WILLIAMS

Provider Business Mailing Address
First Line	:	6531 FM 78 SUITE 110
Second Line	:	BOX 430
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244
Country	:	US
Telephone Number	:	210-584-0158
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 CALLAGHAN RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1127
Country	:	US
Telephone Number	:	726-208-3898
Fax Number	:

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

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	03/18/2025

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Directions to “ EBONY STAR WILLIAMS ” Practice Location

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