Provider Demographics
NPI:1144645615
Name:WILLIAMS, EMILY (MCP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2835
Mailing Address - Country:US
Mailing Address - Phone:580-917-7902
Mailing Address - Fax:
Practice Address - Street 1:202639 E COUNTY ROAD 42
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-5442
Practice Address - Country:US
Practice Address - Phone:580-254-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional