Provider Demographics
NPI:1699984542
Name:WILLIAMS READE, JACQUELINE MICHELLE (MS, PHD, LMFT, LCPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:WILLIAMS READE
Suffix:
Gender:F
Credentials:MS, PHD, LMFT, LCPC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1245 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6680
Mailing Address - Country:US
Mailing Address - Phone:206-406-8683
Mailing Address - Fax:
Practice Address - Street 1:1245 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6680
Practice Address - Country:US
Practice Address - Phone:909-206-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87056106H00000X
MT70359101YM0800X
MT461106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health