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NPI Code Detail

MEDICARE: TENNILLE WILLIAMS

MEDICARE: TENNILLE 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
1101YP2500XProfessional Counselor180.010608IL

General Provider Information

NPI Number : 1366283749
Entity Type Code : Individual
Provider Name (Legal Business Name) : TENNILLE WILLIAMS
Provider Business Mailing Address
First Line : 5539 S PRAIRIE AVE APT B
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1081
Country : US
Telephone Number : 773-820-0182
Fax Number :
Provider Business Practice Location Address
First Line : 5215 N CALIFORNIA AVE STE F101
Second Line :
City : CHICAGO
State : IL
Zip : 60625-0035
Country : US
Telephone Number : 773-561-5809
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2024
Last Update Date : 06/01/2024

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Directions to “ TENNILLE WILLIAMS ” Practice Location

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