MEDICARE: MR. DAVID KECK WILLIAMS MA,LPC

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	101YM0800X	Mental Health Counselor	507	OK

General Provider Information

NPI Number	:	1629010897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID KECK WILLIAMS MA,LPC

Provider Business Mailing Address
First Line	:	524 NW 141ST ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-1917
Country	:	US
Telephone Number	:	405-749-2188
Fax Number	:	405-755-6707

Provider Business Practice Location Address
First Line	:	9636 N MAY AVE
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2727
Country	:	US
Telephone Number	:	405-749-2188
Fax Number	:	405-755-6707

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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