Provider Demographics
NPI:1649505868
Name:WILLIAMS, ALAN S (LPT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 REDWATER DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4978
Mailing Address - Country:US
Mailing Address - Phone:916-833-0222
Mailing Address - Fax:
Practice Address - Street 1:8916 REDWATER DR
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4978
Practice Address - Country:US
Practice Address - Phone:916-833-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19653167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician