Provider Demographics
NPI:1063582567
Name:WILLIAMS, TAMI MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N ORANGE ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2998
Mailing Address - Country:US
Mailing Address - Phone:406-327-3371
Mailing Address - Fax:406-327-3390
Practice Address - Street 1:900 N ORANGE ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2998
Practice Address - Country:US
Practice Address - Phone:406-327-3371
Practice Address - Fax:406-327-3390
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256984Medicaid