Provider Demographics
NPI:1689545451
Name:WILLIAMS, TERRELL LAMAR
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:LAMAR
Last Name:WILLIAMS
Suffix:
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 1:15260 VENTURA BLVD STE 1140
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5346
Mailing Address - Country:US
Mailing Address - Phone:661-947-9554
Mailing Address - Fax:310-948-9573
Practice Address - Street 1:15260 VENTURA BLVD STE 1140
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5346
Practice Address - Country:US
Practice Address - Phone:661-947-9554
Practice Address - Fax:310-948-9573
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW1604034106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty