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NPI Code Detail

MEDICARE: JEFFREY WAYNE WILLIAMS LCDC

MEDICARE:   JEFFREY WAYNE WILLIAMS  LCDC
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) Counselor5392TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1462564OTHERTXVALUE OPTION
28513BHOTHERTXBCBS INDIVIDUAL
30086JBOTHERTXBCBS GRP

General Provider Information

NPI Number : 1548383904
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY WAYNE WILLIAMS LCDC
Provider Business Mailing Address
First Line : PO BOX 12205
Second Line :
City : SPRING
State : TX
Zip : 77391-2205
Country : US
Telephone Number : 281-353-8333
Fax Number : 281-353-8367
Provider Business Practice Location Address
First Line : 4405 SPRING CYPRESS RD
Second Line : SUITE 111
City : SPRING
State : TX
Zip : 77388-4400
Country : US
Telephone Number : 281-353-8333
Fax Number : 281-353-8367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 01/23/2008

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