Provider Information for 1225684376
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Mr. BRYAN MICAHL WILLIAMS LCSW
Sex: Male
NPI: 1225684376
Last Updated: 2025-01-09
Certification Date: 2025-01-09
Certification Date: 2025-01-09
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225684376 | ||||||||
| Enumeration Date | 2019-08-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4555 SAN JACINTO AVE ATASCADERO, CA 93422-3021 United States Phone: 760-220-8313 | Fax: | ||||||||
| Primary Practice Address | 10333 EL CAMINO REAL ATASCADERO, CA 93422-5808 United States Phone: 805-468-3552 | Fax: | ||||||||
| Secondary Practice Address(es) | 4555 SAN JACINTO AVE 2975 MCMILLAN AVE STE 164 | ||||||||
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