Healthcare Provider Details

I. General information

NPI: 1316901077
Provider Name (Legal Business Name): BETSY LU EL WILLIAMS PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 PHOENIX NE SUITE 107
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

5400 PHOENIX NE SUITE 107
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-2828
  • Fax: 505-872-2828
Mailing address:
  • Phone: 505-872-2828
  • Fax: 505-872-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1495
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: