Provider Demographics
NPI:1871081638
Name:WILLIAMS, REATA CONCEATA
Entity type:Individual
Prefix:MS
First Name:REATA
Middle Name:CONCEATA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 GOULD DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4971
Mailing Address - Country:US
Mailing Address - Phone:318-584-7268
Mailing Address - Fax:318-584-7195
Practice Address - Street 1:1007 GOULD DR STE 1
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4971
Practice Address - Country:US
Practice Address - Phone:318-584-7268
Practice Address - Fax:318-584-7195
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty