Doctor Name: | DR. JESSICA WILLIAMS |
NPI Number: | 1063790483 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | PSY27548 |
Business Practice Address: | 13800 Heacock St Suitc C230d Moreno Valley, CA - 925533339 |
Business Phone Number: | 9514215967 |
Business Fax Number: | |
Mailing Address: | Po Box 1484, CHINO |
State: | CA |
Postal Code: | 917081484 |
Phone Number: | 9514215967 |
Fax Number: | |
NPI Enumeration Date: | 08/02/2011 |
NPI Last Update Date: | 05/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY27548 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |