Provider Demographics
NPI:1063790483
Name:WILLIAMS, JESSICA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 HEACOCK ST STE C230D
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3339
Mailing Address - Country:US
Mailing Address - Phone:951-421-5967
Mailing Address - Fax:951-823-5518
Practice Address - Street 1:13800 HEACOCK ST
Practice Address - Street 2:SUITC C230D
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3339
Practice Address - Country:US
Practice Address - Phone:951-421-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27548103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical