Provider Demographics
NPI:1376600742
Name:WILLIAMS, JOHN S (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13601 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVENUE WEST
Practice Address - Street 2:SUITE 310N THE COURT INTERNATIONAL BUILDING
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-379-5157
Practice Address - Fax:651-379-5159
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2293103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN444T4WIOtherBCBS
MNHP20649OtherHEATH PARTNERS