Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1043539182 |
---|---|
Provider Name | Edward P Williams |
First Address | Poteau, OK 74953 |
Second Address | Poteau, OK 74953-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2010 |
Last Update Date | 29/07/2020 |