MEDICARE: CARMEN WILLIAMS 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	C.2405782	OH

General Provider Information

NPI Number	:	1316785769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN WILLIAMS LPC

Provider Business Mailing Address
First Line	:	701 WILLOW DR
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-2028
Country	:	US
Telephone Number	:	216-990-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 ROCKSIDE RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-4525
Country	:	US
Telephone Number	:	216-245-8249
Fax Number	:

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/24/2024

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