Provider Demographics
NPI:1225117153
Name:WILLIAMS, JACQUELYN T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:T
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 1:4606 REDBIRD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7873
Mailing Address - Country:US
Mailing Address - Phone:805-907-2778
Mailing Address - Fax:805-496-6862
Practice Address - Street 1:4606 REDBIRD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7873
Practice Address - Country:US
Practice Address - Phone:805-907-2778
Practice Address - Fax:805-496-6862
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist