MEDICARE: KATHRYN JEAN 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	101YM0800X	Mental Health Counselor	IMH17361	FL

General Provider Information

NPI Number	:	1710686373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN JEAN WILLIAMS

Provider Business Mailing Address
First Line	:	1907 PALMETTO PALM CIR
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-3521
Country	:	US
Telephone Number	:	850-865-5141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 PALMETTO PALM CIR
Second Line	:
City	:	NICEVILLE
State	:	FL
Zip	:	32578-3521
Country	:	US
Telephone Number	:	850-865-5141
Fax Number	:

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

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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Directions to “ KATHRYN JEAN WILLIAMS ” Practice Location

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