Provider Demographics
NPI:1538932330
Name:WILLIAMS, TENISE (IMH23015)
Entity type:Individual
Prefix:
First Name:TENISE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:IMH23015
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 LAKE MONTEREY CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8442
Mailing Address - Country:US
Mailing Address - Phone:561-573-0274
Mailing Address - Fax:
Practice Address - Street 1:284 LAKE MONTEREY CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8442
Practice Address - Country:US
Practice Address - Phone:561-573-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health