Healthcare Provider Details

I. General information

NPI: 1366170755
Provider Name (Legal Business Name): WILLIAMS PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MONROE ST # 308
BLOOMINGTON IL
61701-3997
US

IV. Provider business mailing address

624 NORMAL AVE
NORMAL IL
61761-1528
US

V. Phone/Fax

Practice location:
  • Phone: 877-358-4200
  • Fax:
Mailing address:
  • Phone: 877-358-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CEDRIC WILLIAMS
Title or Position: CEO
Credential: PHD
Phone: 877-358-4200