Provider Demographics
NPI:1932610821
Name:WILLIAMS, WILLARD EUGENE SR (DOCTORATE)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:EUGENE
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 S MAJESTIC AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1170
Mailing Address - Country:US
Mailing Address - Phone:909-561-2209
Mailing Address - Fax:
Practice Address - Street 1:450 WEST 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-502-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3676992103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty