Provider Demographics
NPI:1942953823
Name:WILLIAMSON, EZRA BRANDON I (LPC)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:BRANDON
Last Name:WILLIAMSON
Suffix:I
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-464-6671
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:480 PILGRIM WAY # 1300-A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5280
Practice Address - Country:US
Practice Address - Phone:920-610-5119
Practice Address - Fax:920-610-5120
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional