Provider Demographics
NPI:1780175109
Name:WILLIAMS, MARY LISABETH
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LISABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12930 CLAYGATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-2704
Mailing Address - Country:US
Mailing Address - Phone:281-630-8769
Mailing Address - Fax:
Practice Address - Street 1:12930 CLAYGATE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-2704
Practice Address - Country:US
Practice Address - Phone:281-630-8769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility