Provider Demographics
NPI:1205888427
Name:WILLIAMS, ELLEN WEISS (PHD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:WEISS
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 1:7734 S ALDER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1644
Mailing Address - Country:US
Mailing Address - Phone:480-345-7031
Mailing Address - Fax:480-831-6799
Practice Address - Street 1:7734 S ALDER DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1644
Practice Address - Country:US
Practice Address - Phone:480-345-7031
Practice Address - Fax:480-831-6799
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZPHD462Medicare PIN