Basic Information
| Provider Information | |||||||||
| NPI: | 1730369877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREGORY L. WILLIAMS, PSY.D., PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 COOPER POINT RD SW STE 17 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607544662 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 COOPER POINT RD SW STE 17 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607544662 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 03/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3607544662 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY2410 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7119985 | 05 | WA | MEDICAID |