Healthcare Provider Details

I. General information

NPI: 1326139361
Provider Name (Legal Business Name): GREGORY LYNN WILLIAMS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 CATON WAY SW
OLYMPIA WA
98502
US

IV. Provider business mailing address

2118 CATON WAY SW
OLYMPIA WA
98502
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-4662
  • Fax: 369-352-3289
Mailing address:
  • Phone: 360-754-4662
  • Fax: 369-352-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002410
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: