Provider Demographics
NPI:1528794476
Name:WILLIAMS, NIA IMANI (MT-BC)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:IMANI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 HIDDEN VALLEY CIR APT B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-1702
Mailing Address - Country:US
Mailing Address - Phone:409-225-4123
Mailing Address - Fax:
Practice Address - Street 1:9432 KATY FWY STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6370
Practice Address - Country:US
Practice Address - Phone:832-481-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17511225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist