Healthcare Provider Details

I. General information

NPI: 1730397027
Provider Name (Legal Business Name): TRACI WILLIAMS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S RURAL RD
TEMPE AZ
85282-3853
US

IV. Provider business mailing address

2175 N MOSLEY DR
CHANDLER AZ
85225-1355
US

V. Phone/Fax

Practice location:
  • Phone: 480-921-9003
  • Fax: 480-829-6179
Mailing address:
  • Phone: 480-969-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: