Individual provider Active NPI

Diane Witson Williams, PSY.D.

  • Clinical Psychologist
  • Coaldale, CO
National Provider Identifier
1578892683
Registry record updated Oct 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2161 Issued in CO
Practice address
247 Fox Creek Drive
Coaldale, CO 81222-0023
Phone
(719) 221-0654
NPI assigned
Dec 18, 2009
Last updated
Oct 18, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2161 CO Primary

Addresses

Primary practice location

247 Fox Creek Drive
Coaldale, CO 81222-0023

Mailing address

PO Box 1569
Salida, CO 81201-7569
Phone (719) 221-0654

Other names 1

  • Diane Williams Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110920000685 CO Practitioner - Clinical Psychologist 0648315317 Practice locations: Salida, CO

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
2161COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mesa View Retirement Home Inc. Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1578892683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1569",
            "city": "SALIDA",
            "state": "CO",
            "postal_code": "812017569",
            "telephone_number": "719-221-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 FOX CREEK DRIVE",
            "city": "COALDALE",
            "state": "CO",
            "postal_code": "812220023",
            "telephone_number": "719-221-0654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DIANE",
        "middle_name": "WITSON",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-18",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "2161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "WILLIAMS",
            "credential": "PSYD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.