MEDICARE: WILLIE LEE WILLIAMS JR. B.S.

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	080516929	OK

General Provider Information

NPI Number	:	1942521950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE LEE WILLIAMS JR. B.S.

Provider Business Mailing Address
First Line	:	13401 SPRUCE VALLEY DR
Second Line	:
City	:	JONES
State	:	OK
Zip	:	73049-8924
Country	:	US
Telephone Number	:	405-990-0549
Fax Number	:	405-455-7122

Provider Business Practice Location Address
First Line	:	7901 NE 10TH ST
Second Line	:	C116
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3600
Country	:	US
Telephone Number	:	405-455-7022
Fax Number	:

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

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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