Provider Demographics
NPI:1619045598
Name:WILLIAMS, JAN SUSAN (MS LPC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 S LAKE HAVASU AVE
Mailing Address - Street 2:#C32
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86043
Mailing Address - Country:US
Mailing Address - Phone:928-505-1550
Mailing Address - Fax:928-505-1550
Practice Address - Street 1:276 S LAKE HAVASU AVE
Practice Address - Street 2:#C32
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-505-1550
Practice Address - Fax:928-505-1550
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health