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Provider Information for 1841343662


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Mr. MICHAEL JEROME WILLIAMS L.P.C.


Sex: Male

NPI: 1841343662
Last Updated: 2009-09-09
Certification Date:

Details

NameValue
NPI1841343662
Enumeration Date2007-01-18
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 9155 HEMIS FAIR DR
SAINT LOUIS, MO 63136-4006
United States

Phone: 314-898-5218 | Fax:
 
Primary Practice Address 9155 HEMIS FAIR DR
SAINT LOUIS, MO 63136-4006
United States

Phone: 314-898-5218 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMO493267322
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalMO000331
No 225700000X - Massage Therapist MO2004003080