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General NPI Number Information
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NPI Number | 1639245962
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Entity Type | Organization
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Legal Business Name | MARK J WILLIAMS PH.D., PLLC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5924 ROYAL LN SUITE 211
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City | DALLAS
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State | TX
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Zip | 75230-3863
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Country | US
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Telephone | 214-927-8456
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Fax | 214-361-2335
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Provider Business Mailing Address
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Address Line | 833 KIRKWOOD DR
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City | DALLAS
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State | TX
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Zip | 75218-2283
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Country | US
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Telephone | 214-927-8456
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Fax | 214-361-2335
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MARK JEFFREY WILLIAMS
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Credential | PH.D.
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Telephone | 214-927-8456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32192
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License Number State | TX
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