Basic Information
Provider Information
NPI: 1649729377
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCWILLIAMS
FirstName: ALLIE
MiddleName: NICHOLE
NamePrefix: MS.
NameSuffix:  
Credential: BA, QMHA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 SHELTON MCMURPHEY BLVD
Address2:  
City: EUGENE
State: OR
PostalCode: 974014928
CountryCode: US
TelephoneNumber: 5414852711
FaxNumber: 8155725513
Practice Location
Address1: 10 SHELTON MCMURPHEY BLVD
Address2:  
City: EUGENE
State: OR
PostalCode: 974014928
CountryCode: US
TelephoneNumber: 5414852711
FaxNumber: 8155725513
Other Information
ProviderEnumerationDate: 09/22/2016
LastUpdateDate: 09/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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