Basic Information
| Provider Information | |||||||||
| NPI: | 1811129364 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | FSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 E. HWY 66 | ||||||||
| Address2: | |||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054228825 | ||||||||
| FaxNumber: | 4052621331 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 E. HWY 66 | ||||||||
| Address2: | |||||||||
| City: | EL RENO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054228825 | ||||||||
| FaxNumber: | 4052621331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 08/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.