Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4848969-6006 | UT |
NPI | 1285100784 |
---|---|
Provider Name | Tracey M Williams |
First Address | Draper, UT 84020 |
Second Address | Draper, UT 84020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2018 |
Last Update Date | 23/10/2018 |