Provider Demographics
NPI:1255610234
Name:WATERS, WILLIAM (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 W MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2460
Mailing Address - Country:US
Mailing Address - Phone:509-492-2162
Mailing Address - Fax:
Practice Address - Street 1:5113 W MARGARET ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2460
Practice Address - Country:US
Practice Address - Phone:509-492-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60704307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical