Provider Demographics
NPI:1386761849
Name:WILLIAMS-MOORE SCHILLING, JOY R (PHD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:R
Last Name:WILLIAMS-MOORE SCHILLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:RUTH
Other - Last Name:WILLIAMSMOORE SCHILLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1538 W COSTILLA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-4247
Mailing Address - Country:US
Mailing Address - Phone:719-634-6737
Mailing Address - Fax:719-362-4402
Practice Address - Street 1:2207 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3324
Practice Address - Country:US
Practice Address - Phone:719-634-6737
Practice Address - Fax:719-362-4402
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC62236Medicare ID - Type Unspecified