Shanna Williams, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301018846 Issued in MI

Practice address

8495 Crater Lake Hwy
White City, OR 97503-3011

Phone

(541) 826-2111

NPI assigned

Oct 24, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Delta Family Clinic South P.C

  • Adult Mental Health Clinic/Center
  • Flint, MI
  • NPI 1255509832
  NPD (past)
• Delta Family Clinic South PC

  • Clinical Psychologist
  • Bay City, MI
  • NPI 1902162746
  NPD (past)

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1851644199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6195 MILLER RD",
            "address_2": "STE A",
            "city": "SWARTZ CREEK",
            "state": "MI",
            "postal_code": "48473",
            "telephone_number": "810-630-1152",
            "fax_number": "810-630-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8495 CRATER LAKE HWY",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975033011",
            "telephone_number": "541-826-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "SHANNA",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-24",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "6301018846",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Shanna.Williams2@va.gov",
            "affiliation": "Y",
            "affiliationName": "Southern Oregon Rehabilitation Center and Clinics VHA",
            "address_1": "8495 Crater Lake Hwy",
            "city": "White City",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975033011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eston Sumner White, MSN RN
• Steven Maxwell White, MD
• Carol Wilcox
• Leonard Mark Wilk, MD
• Kevin Leonard Williams, MSW, LCSW
• Zachary Willits, OD
• Veronica Renee Wizes, FNP
• Micah Wood, MSN, RN
• Rasha Yaghan, FNP
• Beverly Kay Young, MD

• Clinical Psychologist in White City, OR
• Providers in White City, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.