Provider Demographics
NPI:1184370942
Name:WILLIAMS, TAYLOR MIKELA (CMPSS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MIKELA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CMPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2434
Mailing Address - Country:US
Mailing Address - Phone:559-899-0888
Mailing Address - Fax:
Practice Address - Street 1:1040 N PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2434
Practice Address - Country:US
Practice Address - Phone:559-899-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
CAMPSS-IXOKYS175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor