Provider Demographics
NPI:1619678935
Name:WILLIAMS, MATILYN BROOK
Entity type:Individual
Prefix:
First Name:MATILYN
Middle Name:BROOK
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 LAKE CREST CIR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5943
Mailing Address - Country:US
Mailing Address - Phone:931-704-6952
Mailing Address - Fax:
Practice Address - Street 1:1521 LAKE CREST CIR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5943
Practice Address - Country:US
Practice Address - Phone:931-704-6952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1720103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst