MEDICARE: FAYE WILLIAMS AMFT, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1437835469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYE WILLIAMS AMFT, LPC

Provider Business Mailing Address
First Line	:	2708 W GUNNISON ST FLOOR 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-9422
Country	:	US
Telephone Number	:	323-393-0764
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 W GUNNISON ST FLOOR 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-9422
Country	:	US
Telephone Number	:	323-393-0764
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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