Healthcare Provider Details

I. General information

NPI: 1568408730
Provider Name (Legal Business Name): DALE WAYNE WILLIAMS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 SHOAL CREEK BLVD STE. 108
AUSTIN TX
78757-6802
US

IV. Provider business mailing address

2704 BENBROOK DRIVE
AUSTIN TX
78757-6953
US

V. Phone/Fax

Practice location:
  • Phone: 512-576-8656
  • Fax: 512-459-2101
Mailing address:
  • Phone: 512-576-8656
  • Fax: 512-459-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number21580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: