Healthcare Provider Details

I. General information

NPI: 1932889268
Provider Name (Legal Business Name): RIVER WILLIAMS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODIE WAITS

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 O ST STE 211
LINCOLN NE
68510-1864
US

IV. Provider business mailing address

4435 O ST STE 211
LINCOLN NE
68510-1864
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-2218
  • Fax: 402-489-3666
Mailing address:
  • Phone: 402-489-2218
  • Fax: 402-489-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13435
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1195
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: