Provider Demographics
NPI:1154602381
Name:WILLIAMS-STEAN, CHERYL D (MMT,AD)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:D
Last Name:WILLIAMS-STEAN
Suffix:
Gender:F
Credentials:MMT,AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BARRYWOOD ST APT 1624
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1751
Mailing Address - Country:US
Mailing Address - Phone:817-986-6562
Mailing Address - Fax:
Practice Address - Street 1:3309 CAMP BOWIE STE#90
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1751
Practice Address - Country:US
Practice Address - Phone:817-451-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX102X00000X, 171W00000X, 1744G0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No1744G0900XOther Service ProvidersSpecialistGraphics Designer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLOV14ARTMedicaid
TX1154602381Medicare PIN