=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003939075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. LINN DOUGLAS WILLIAMSON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3091 ALHAMBRA DR STE E
-----------------------------------------------------
City | CAMERON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95682-7635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-306-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 704
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95623-0704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-306-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT 022607
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------