MEDICARE: ANGELA MICHELLE 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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1659712768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MICHELLE WILLIAMS

Provider Business Mailing Address
First Line	:	5413 BLOSSOM GARDENS CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-6144
Country	:	US
Telephone Number	:	408-449-8831
Fax Number	:

Provider Business Practice Location Address
First Line	:	5413 BLOSSOM GARDENS CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-6144
Country	:	US
Telephone Number	:	408-449-8831
Fax Number	:

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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