Basic Information
| Provider Information | |||||||||
| NPI: | 1467787093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | JACK | ||||||||
| OtherMiddleName: | D. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1315 W COLLEGE AVE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168012776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144415738 | ||||||||
| FaxNumber: | 8148615163 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 W COLLEGE AVE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168012776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144415738 | ||||||||
| FaxNumber: | 8148615163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 06/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS004377L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.