Jakob Daniel Williams, M.S. LLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6361007731 Issued in MI

Practice address

1 Heritage Dr Ste 520
Southgate, MI 48195-3051

Phone

(734) 215-9800

NPI assigned

Apr 22, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michigan Modern Psychology Group,PLLC

  • Clinical Psychologist
  • Dearborn, MI
  • NPI 1447701255
  NPD (past)
• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1083277339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 ANTOINE ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481923306",
            "telephone_number": "734-512-8136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HERITAGE DR STE 520",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481953051",
            "telephone_number": "734-215-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JAKOB",
        "middle_name": "DANIEL",
        "credential": "M.S. LLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-22",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301017702",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361007731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Maurice Williams, MSN, RN, PMHNP-BC
• Arecia Williams, LLPC
• Calynn Williams
• Diamond Alexus Williams
• India Monaee Williams
• Jenai Tifani Williams
• Katelyn Williams
• Kelsey Lee Williams
• Kendra Tinae Williams
• Kristal Nujuan Williams, BA

• Psychologist in Southgate, MI
• Providers in Southgate, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.