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NPI Code Detail

MEDICARE: MR. MARCUS WILLIAMS

MEDICARE: MR. MARCUS 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1457741654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARCUS WILLIAMS
Provider Business Mailing Address
First Line : 4045 SPENCER ST STE A45
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5245
Country : US
Telephone Number : 702-637-9011
Fax Number :
Provider Business Practice Location Address
First Line : 4045 SPENCER ST STE A45
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5245
Country : US
Telephone Number : 702-637-9011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2015
Last Update Date : 01/27/2015

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