MEDICARE: DR. CARL L WILLIAMS PH.D,

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	101YP2500X	Professional Counselor	0101061	NM

General Provider Information

NPI Number	:	1508086042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL L WILLIAMS PH.D,

Provider Business Mailing Address
First Line	:	4822 CAMPBELL RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6835
Country	:	US
Telephone Number	:	150-552-4581
Fax Number	:	150-552-4581

Provider Business Practice Location Address
First Line	:	4822 CAMPBELL RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6835
Country	:	US
Telephone Number	:	150-552-4581
Fax Number	:	150-552-4581

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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