MEDICARE: BRIAUNA L 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356780118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAUNA L WILLIAMS

Provider Business Mailing Address
First Line	:	2895 E CHARLESTON BLVD APT 2071
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2895 E CHARLESTON #2071
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	US
Telephone Number	:	702-981-4304
Fax Number	:

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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