Provider Demographics
NPI:1851765036
Name:WILLIAMS, MARLEEN S (PHD)
Entity Type:Individual
Prefix:
First Name:MARLEEN
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S STATE ST
Mailing Address - Street 2:STE 1
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6326
Mailing Address - Country:US
Mailing Address - Phone:801-225-9522
Mailing Address - Fax:801-225-9498
Practice Address - Street 1:703 S STATE ST
Practice Address - Street 2:STE 1
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6326
Practice Address - Country:US
Practice Address - Phone:801-225-9522
Practice Address - Fax:801-225-9498
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT296279-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical