Organization
NATHAN L WILLIAMS PHD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVONNA M LATTA (OFFICE MANAGER)
(479) 443-5575
Entity
Organization
Contact information
Practice address
1 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1825
(479) 443-5575
(479) 443-9554
Mailing address
1 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1825
(479) 443-5575
(479) 443-9554
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0319P
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952327637
BLUE CROSS BLUE SHIELD
AR
Enumeration date
01/15/2009
Last updated
01/15/2009
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