Provider Demographics
NPI:1831442870
Name:WILLIAMS, TODD QUINN (MS, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:QUINN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12433 W RUTHERFORD CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0014
Mailing Address - Country:US
Mailing Address - Phone:208-908-3599
Mailing Address - Fax:
Practice Address - Street 1:12433 W RUTHERFORD CT
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0014
Practice Address - Country:US
Practice Address - Phone:208-908-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7218101YP2500X, 101YM0800X
IDLPC-4995101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCPC-7218OtherIBOL LICENSE NUMBER