MEDICARE: MS. MICHEL'LE 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	101Y00000X	Counselor	PLC9589	LA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1396383675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHEL'LE WILLIAMS

Provider Business Mailing Address
First Line	:	1714 AYCOCK ST
Second Line	:
City	:	ARABI
State	:	LA
Zip	:	70032-1417
Country	:	US
Telephone Number	:	504-388-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	5475 ESSEN LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3737
Country	:	US
Telephone Number	:	225-226-5947
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	07/14/2023

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