Active NPI
Jim O Williams, MA
- Mental Health Counselor
- Renton, WA
National Provider Identifier
1609166289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MC 60155945
- Practice address
- 15 S Grady Way
Evergreen BLDG. - Suite LL24
Renton, WA 98057-3220 - Phone
- (425) 306-6703
- NPI assigned
- Apr 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MC 60155945 | WA | Primary |
Addresses
Primary practice location
15 S Grady Way
Evergreen BLDG. - Suite LL24
Renton, WA 98057-3220
Mailing address
15 S Grady Way
Evergreen BLDG. - Suite LL24
Renton, WA 98057-3220
Phone (425) 306-6703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC 60155945 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302825600000",
"number": "1609166289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 S GRADY WAY",
"address_2": "EVERGREEN BLDG. - SUITE LL24",
"city": "RENTON",
"state": "WA",
"postal_code": "980573220",
"telephone_number": "425-306-6703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 S GRADY WAY",
"address_2": "EVERGREEN BLDG. - SUITE LL24",
"city": "RENTON",
"state": "WA",
"postal_code": "980573220",
"telephone_number": "425-306-6703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JIM",
"middle_name": "O",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-15",
"last_updated": "2011-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "MC 60155945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.