Evelyn Williams, CLINICAL DIRECTOR

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Practice address

20348 E Warner Rd
Mesa, AZ 85212-9655

Phone

(480) 751-7483

Fax

(480) 279-3828

NPI assigned

Aug 25, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 11

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gleneagle Mental Health Agencies Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Mesa, AZ
  • NPI 1013244813

  Community/Behavioral Health

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

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    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1548417231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20348 E WARNER RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852129655",
            "telephone_number": "480-751-7483",
            "fax_number": "480-279-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20348 E WARNER RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852129655",
            "telephone_number": "480-751-7483",
            "fax_number": "480-279-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "EVELYN",
        "credential": "CLINICAL DIRECTOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-25",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "102X00000X",
            "taxonomy_group": "",
            "desc": "Poetry Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "438547",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cody Williams, RBT
• Dara Lynn Williams, RN
• Dawn Lynn Williams, NURSE PRACTITIONER
• Deanne Williams, LPC
• Demonte Williams, PRSS,CHW
• J. Ladd Williams, D.D.S.
• Jacquelyn Williams, MS SLPCF COMMUNICATI
• Jalen Williams
• James Alton Williams, MD
• Jared Bowman Williams, D.D.S.

• Mental Illness Community Based Residential Treatment Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.