MEDICARE: DR. ROQUEL A WILLIAMS PHD, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TP0016X	Prescribing (Medical) Psychologist
2	103G00000X	Clinical Neuropsychologist
3	102L00000X	Psychoanalyst
4	103TR0400X	Rehabilitation Psychologist
5	103TP2701X	Group Psychotherapy Psychologist
6	103TA0400X	Addiction (Substance Use Disorder) Psychologist
7	103TF0200X	Forensic Psychologist
8	103TS0200X	School Psychologist
9	173F00000X	Sleep Specialist (PhD)
10	102X00000X	Poetry Therapist

General Provider Information

NPI Number	:	1073826186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROQUEL A WILLIAMS PHD, MD

Provider Business Mailing Address
First Line	:	566 E 71ST ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-4404
Country	:	US
Telephone Number	:	318-865-2888
Fax Number	:	318-865-2814

Provider Business Practice Location Address
First Line	:	566 E 71ST ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-4404
Country	:	US
Telephone Number	:	318-865-2888
Fax Number	:	318-865-2814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2010
Last Update Date	:	08/25/2010

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