Basic Information
| Provider Information | |||||||||
| NPI: | 1851564934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | BETSY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PSYD, BCPC, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2285 BENTON RD STE D103 | ||||||||
| Address2: | |||||||||
| City: | BOSSIER CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711113465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185847197 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2800 YOUREE DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711043660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182100928 | ||||||||
| FaxNumber: | 3184259644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2008 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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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 | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.