MEDICARE: WILLIAM WELLS FRIDAY PH.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4081	OH
2	103TF0000X	Family Psychologist	4081	OH
3	103TH0100X	Health Service Psychologist	4081	OH
4	103T00000X	Psychologist	4081	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871668046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM WELLS FRIDAY PH.D.

Provider Business Mailing Address
First Line	:	5340 E MAIN ST
Second Line	:	SUITE 205
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2574
Country	:	US
Telephone Number	:	614-501-8220
Fax Number	:	614-501-8230

Provider Business Practice Location Address
First Line	:	5340 E MAIN ST
Second Line	:	SUITE 205
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2574
Country	:	US
Telephone Number	:	614-501-8220
Fax Number	:	614-501-8230

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	02/01/2012

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Directions to “ WILLIAM WELLS FRIDAY PH.D.” Practice Location

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