Provider Demographics
NPI:1174753750
Name:WILLIAMS, TINA (LIMHP, LMHP, LPC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LIMHP, LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 5TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1745
Mailing Address - Country:US
Mailing Address - Phone:308-765-1386
Mailing Address - Fax:
Practice Address - Street 1:2621 5TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-1745
Practice Address - Country:US
Practice Address - Phone:308-765-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE624101YM0800X
NE3515101YM0800X
NE2050101YP2500X
NE1063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)