Provider Demographics
NPI:1710623202
Name:WILLIAMS, JANIE RENEE (EDS, PLPC)
Entity type:Individual
Prefix:MS
First Name:JANIE
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:EDS, PLPC
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:RENEE
Other - Last Name:GUILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS, LPCP
Mailing Address - Street 1:237 CREEKSIDE OFFICE DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-202-1412
Mailing Address - Fax:636-201-3379
Practice Address - Street 1:237 CREEKSIDE OFFICE DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-202-1412
Practice Address - Fax:636-201-3379
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024029980101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator