MEDICARE: KIMBERLEY L WILLIAMS LCSW

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	1041C0700X	Clinical Social Worker	64415	TX

General Provider Information

NPI Number	:	1508661174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY L WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	MURCHISON
State	:	TX
Zip	:	75778-0158
Country	:	US
Telephone Number	:	903-330-9592
Fax Number	:	903-470-7373

Provider Business Practice Location Address
First Line	:	10697 COUNTY ROAD 159
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3327
Country	:	US
Telephone Number	:	903-330-9592
Fax Number	:	903-470-7373

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

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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