Provider Demographics
NPI:1639245962
Name:MARK J WILLIAMS PH.D., PLLC
Entity Type:Organization
Organization Name:MARK J WILLIAMS PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-927-8456
Mailing Address - Street 1:833 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2283
Mailing Address - Country:US
Mailing Address - Phone:214-927-8456
Mailing Address - Fax:214-361-2335
Practice Address - Street 1:5924 ROYAL LN
Practice Address - Street 2:SUITE 211
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3863
Practice Address - Country:US
Practice Address - Phone:214-927-8456
Practice Address - Fax:214-361-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32192103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty