Provider Demographics
NPI:1063661569
Name:WILLIAMS, KELLEY MARTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:MARTIN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16441 SPACE CENTER BLVD
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-480-7554
Mailing Address - Fax:281-480-4641
Practice Address - Street 1:16441 SPACE CENTER BLVD
Practice Address - Street 2:SUITE C-100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-480-7554
Practice Address - Fax:281-480-4641
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34916103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent