Provider Demographics
NPI:1285902296
Name:WILLIAMS, JESSICA LYNN (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9962 LIN FERRY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST.. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123
Mailing Address - Country:US
Mailing Address - Phone:314-843-0043
Mailing Address - Fax:
Practice Address - Street 1:9962 LIN FERRY RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:ST.. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6961
Practice Address - Country:US
Practice Address - Phone:314-843-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional