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NPI Code Detail

MEDICARE: MR. PERRY LAVELL WILLIAMS SUDPT

MEDICARE: MR. PERRY LAVELL WILLIAMS SUDPT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1417138108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PERRY LAVELL WILLIAMS SUDPT
Provider Business Mailing Address
First Line : PO BOX 1207
Second Line :
City : YAKIMA
State : WA
Zip : 98907-1207
Country : US
Telephone Number : 509-941-4915
Fax Number : 510-713-0684
Provider Business Practice Location Address
First Line : 201 E LINCOLN AVE STE 100
Second Line :
City : YAKIMA
State : WA
Zip : 98901-2348
Country : US
Telephone Number : 509-941-4915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2007
Last Update Date : 02/28/2022

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