MEDICARE: DR. LORI DEE WILLIAMS PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY15389	CA

General Provider Information

NPI Number	:	1255632535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI DEE WILLIAMS PH.D

Provider Business Mailing Address
First Line	:	4393 W PINSAPO DR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-6459
Country	:	US
Telephone Number	:	559-977-1556
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 W SHAW AVE STE 200
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2515
Country	:	US
Telephone Number	:	559-977-1556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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