MEDICARE: LEONARD E 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00000772	WA

General Provider Information

NPI Number	:	1376764100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD E WILLIAMS

Provider Business Mailing Address
First Line	:	1711 COLLINS RD
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-8922
Country	:	US
Telephone Number	:	509-698-5013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 COLLINS RD
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-8922
Country	:	US
Telephone Number	:	509-698-5013
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	11/01/2010

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