MEDICARE: MR. LABRENTE' LEON 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

General Provider Information

NPI Number	:	1801105002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LABRENTE' LEON WILLIAMS

Provider Business Mailing Address
First Line	:	4955 JEFFREYS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4955 JEFFREYS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7738
Country	:	US
Telephone Number	:	407-235-0164
Fax Number	:

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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