MEDICARE: MR. MICHAEL RAY WILLIAMS BS, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	C2008605	CA

General Provider Information

NPI Number	:	1316967276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL RAY WILLIAMS BS, CADC

Provider Business Mailing Address
First Line	:	631 S BROOKHURST ST
Second Line	:	SUITE 106
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3510
Country	:	US
Telephone Number	:	714-490-7711
Fax Number	:	714-490-7717

Provider Business Practice Location Address
First Line	:	631 S BROOKHURST ST
Second Line	:	SUITE 106
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3510
Country	:	US
Telephone Number	:	714-490-7711
Fax Number	:	714-490-7717

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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