Basic Information
| Provider Information | |||||||||
| NPI: | 1609186154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | KRISHELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CROW CANYON CT | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885318385 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 CROW CANYON CT | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885318385 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.