Provider Demographics
NPI:1861530834
Name:WILLIAMS, BRIAN KEITH (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-2703
Mailing Address - Country:US
Mailing Address - Phone:979-822-1862
Mailing Address - Fax:
Practice Address - Street 1:408 TARROW ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-7811
Practice Address - Country:US
Practice Address - Phone:979-268-1111
Practice Address - Fax:979-268-5803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist