Healthcare Provider Details

I. General information

NPI: 1871668046
Provider Name (Legal Business Name): WILLIAM WELLS FRIDAY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 E MAIN ST SUITE 205
COLUMBUS OH
43213-2574
US

IV. Provider business mailing address

5340 E MAIN ST SUITE 205
COLUMBUS OH
43213-2574
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-8220
  • Fax: 614-501-8230
Mailing address:
  • Phone: 614-501-8220
  • Fax: 614-501-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4081
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4081
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4081
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number4081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: