Provider Demographics
NPI:1447086467
Name:WILLIAMS, TIMOTHY JR
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 WEST BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1738
Mailing Address - Country:US
Mailing Address - Phone:216-379-2329
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST STE 320
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1091
Practice Address - Country:US
Practice Address - Phone:216-417-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT595878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health