MEDICARE: DUSTYN SALSBURY WILLIAMS M.A., L.M.H.C.

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	FL MH 10133	FL

General Provider Information

NPI Number	:	1720319767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTYN SALSBURY WILLIAMS M.A., L.M.H.C.

Provider Business Mailing Address
First Line	:	4651 SALISBURY RD STE 417
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	904-294-7023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 SALISBURY RD STE 417
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	904-294-7023
Fax Number	:

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	04/01/2010

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