Provider Demographics
NPI:1699131722
Name:WILLIAMS, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 W 6TH PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9589
Mailing Address - Country:US
Mailing Address - Phone:509-212-9139
Mailing Address - Fax:
Practice Address - Street 1:3311 W CLEARWATER AVE # D266
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2710
Practice Address - Country:US
Practice Address - Phone:509-212-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60628778101YM0800X
WA60628778101YM0800X
WACG 60395760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health