Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 41484 | TX |
Y | 101YP2500X | Professional Counselor | 41484 | TX |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 41484 | TX |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 41484 | TX |
N | 103TP2701X | Group Psychotherapist | 41484 | TX |
NPI | 1184215766 |
---|---|
Provider Name | Mr. James Edward Williams JR. |
First Address | Killeen, TX 76542-3313 |
Second Address | Killeen, TX 76542-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 27/01/2021 |