Provider Demographics
NPI:1982943478
Name:WILLIAMS PSYCHOLOGY INC.
Entity Type:Organization
Organization Name:WILLIAMS PSYCHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-375-6402
Mailing Address - Street 1:3771 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5005
Mailing Address - Country:US
Mailing Address - Phone:208-375-6402
Mailing Address - Fax:888-505-3331
Practice Address - Street 1:3771 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5005
Practice Address - Country:US
Practice Address - Phone:208-375-6402
Practice Address - Fax:888-505-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 202563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty