Active NPI
Mark Williams, PH.D.
- Psychologist
- Dallas, TX
National Provider Identifier
1811020076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 32192
- Practice address
- 18170 Dallas Pkwy Ste 502
Dallas, TX 75287-7151 - Phone
- (214) 351-6600
- Fax
- (214) 351-6453
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 32192 | TX | Primary |
Addresses
Primary practice location
18170 Dallas Pkwy Ste 502
Dallas, TX 75287-7151
Mailing address
16227 Shadybank Dr
Dallas, TX 75248-2958
Phone (469) 855-3008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080305000221 | TX | Practitioner - Clinical Psychologist | 4284719972 | Practice locations: Dallas, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2001
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
17740 Preston Rd
Suite 100C
Dallas, TX 75252-5827
Phone (214) 927-8456
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32192 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721606400000",
"number": "1811020076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16227 SHADYBANK DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752482958",
"telephone_number": "469-855-3008",
"fax_number": "214-351-6453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18170 DALLAS PKWY STE 502",
"city": "DALLAS",
"state": "TX",
"postal_code": "752877151",
"telephone_number": "214-351-6600",
"fax_number": "214-351-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "MARK",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2024-07-22",
"certification_date": "2024-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "32192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.