Basic Information
| Provider Information | |||||||||
| NPI: | 1548710148 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SETH S WILLIAMS PSYD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6107 SW MURRAY BLVD | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970084421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037520122 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Practice Location | |||||||||
| Address1: | 14511 WESTLAKE DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970357783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037520122 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2016 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | SETH | ||||||||
| AuthorizedOfficialMiddleName: | SATURN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5037520122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2227 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.