Healthcare Provider Details

I. General information

NPI: 1740386879
Provider Name (Legal Business Name): DANIEL JACOB WILLIAMS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W 1ST NORTH ST
MORRISTOWN TN
37814-4548
US

IV. Provider business mailing address

PO BOX 1678
MORRISTOWN TN
37816-1678
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-5342
  • Fax: 423-581-8650
Mailing address:
  • Phone: 423-581-5342
  • Fax: 423-581-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8856
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2951
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8856
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2951
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: