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NPI Code Detail

MEDICARE: MR. KEVIN JAMES WILLIAMSON PCC-S

MEDICARE: MR. KEVIN JAMES WILLIAMSON PCC-S
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
1101YM0800XMental Health Counselor0701002759VA
2101YM0800XMental Health CounselorE.0008231-SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1334394OTHERTRIGON PPU
2023469000OTHERVAMAGELLAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4334392OTHERTRIGON PPU
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6334393OTHERTRIGON PPU

General Provider Information

NPI Number : 1386622934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN JAMES WILLIAMSON PCC-S
Provider Business Mailing Address
First Line : 3500 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2641
Country : US
Telephone Number : 440-260-8436
Fax Number : 440-260-8576
Provider Business Practice Location Address
First Line : 3500 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2641
Country : US
Telephone Number : 440-260-8436
Fax Number : 440-260-8576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 01/13/2012

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