Provider Demographics
NPI:1235116203
Name:WILLIAMS, R. GORDON (PHD)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:GORDON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 KENTUCKY DAM RD
Mailing Address - Street 2:PO BOX 3126
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9472
Mailing Address - Country:US
Mailing Address - Phone:270-898-4044
Mailing Address - Fax:270-898-4045
Practice Address - Street 1:6025 KENTUCKY DAM RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9472
Practice Address - Country:US
Practice Address - Phone:270-898-4044
Practice Address - Fax:270-898-4045
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist