Individual
MR. MICKEY DALE WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 440-3532
Mailing address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 440-3532
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
201399
TX
106H00000X
Marriage & Family Therapist
Primary
T0822
OR
Other
Enumeration date
08/23/2010
Last updated
08/10/2012
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