Basic Information
| Provider Information | |||||||||
| NPI: | 1669592812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2977 E TOWNSHIP ROAD 130 | ||||||||
| Address2: | |||||||||
| City: | TIFFIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448839680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194476364 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 S TAFT AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193346619 | ||||||||
| FaxNumber: | 4193346671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | E0900056 | 01 | OH | LICENSE | OTHER |