MEDICARE: JUANITA 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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	00318-LC	NV
3	101YM0800X	Mental Health Counselor	292672
4	101YP2500X	Professional Counselor	CP0176	NV

General Provider Information

NPI Number	:	1700160629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA WILLIAMS

Provider Business Mailing Address
First Line	:	1917 NAVARRE LN
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-5106
Country	:	US
Telephone Number	:	702-355-4376
Fax Number	:

Provider Business Practice Location Address
First Line	:	8933 W SAHARA AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5932
Country	:	US
Telephone Number	:	702-355-4376
Fax Number	:

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

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	05/16/2023

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Directions to “ JUANITA WILLIAMS ” Practice Location

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