Basic Information
| Provider Information | |||||||||
| NPI: | 1578719001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HOSKING AVE APT 77D | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933075741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263797360 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2737 W. CECIL AVE | ||||||||
| Address2: | |||||||||
| City: | DELANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 83215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617212345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PSY24121 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.