Basic Information
| Provider Information | |||||||||
| NPI: | 1417138108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | LAVELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SUDPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1207 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989071207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099414915 | ||||||||
| FaxNumber: | 5107130684 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 E LINCOLN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989012348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099414915 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2007 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.