Provider Demographics
NPI:1598068223
Name:WILLIAMS, KRISTIN KEOUGH (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KEOUGH
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 1:4100 W KENNEDY BLVD STE 223
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2244
Mailing Address - Country:US
Mailing Address - Phone:813-846-2690
Mailing Address - Fax:138-407-6117
Practice Address - Street 1:4100 W KENNEDY BLVD STE 223
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2244
Practice Address - Country:US
Practice Address - Phone:813-846-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical