Doctor Name: | EDWARD P WILLIAMS |
NPI Number: | 1043539182 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MED/PSRS |
License Number: | |
Business Practice Address: | 23755 Lindale Ranch Rd Poteau, OK - 749539071 |
Business Phone Number: | 9186584413 |
Business Fax Number: | |
Mailing Address: | 23755 Lindale Ranch Rd, POTEAU |
State: | OK |
Postal Code: | 74953 |
Phone Number: | 9186584413 |
Fax Number: | |
NPI Enumeration Date: | 05/28/2010 |
NPI Last Update Date: | 08/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |