Provider Demographics
NPI:1326139361
Name:WILLIAMS, GREGORY LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 CATON WAY SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-754-4662
Mailing Address - Fax:369-352-3289
Practice Address - Street 1:2118 CATON WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-754-4662
Practice Address - Fax:369-352-3289
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119985Medicaid
WA0178084OtherL & I
WA1026WIOtherREGENCE RIDER
WA1026WIOtherREGENCE RIDER
WA7119985Medicaid