Individual provider Active NPI

Meredith Williamson, PH.D.

  • Clinical Psychologist
  • Bryan, TX
National Provider Identifier
1891157707
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
37242 Issued in TX
Practice address
2900 E 29TH St Ste 200
Bryan, TX 77802-2623
Phone
(979) 776-8440
Fax
(877) 607-5854
NPI assigned
Mar 22, 2016
Last updated
Jul 15, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 37242 TX Primary
Counseling Psychologist 103TC1900X 37242 TX
Health Psychologist 103TH0004X 37242 TX

Addresses

Primary practice location

2900 E 29TH St Ste 200
Bryan, TX 77802-2623

Mailing address

2900 E 29TH St Ste 100
Bryan, TX 77802-2623
Phone (979) 776-8440

Other practice location 1

3107 8th Ave Apt 103
Fort Worth, TX 76110-3820
Phone (469) 585-4474

Other identifiers 1

IdentifierTypeStateIssuer
370439701MedicaidTX

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170602000303 TX Practitioner - Clinical Psychologist 9436426004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2900 E 29TH St
Suite 200
Bryan, TX 77802-2623
Phone (979) 776-8440

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
37242TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Texas a&M University System Health Science Center CurrentSince May 12, 2017 Accepting new patients
Texas a&M University System Health Science Center CurrentSince May 12, 2017 Accepting new patients

Locations

1301 Memorial Dr
Ste 100
Bryan, TX 77802
Phone (979) 862-4465

2900 E 29th St
Bryan, TX 77802
Phone (979) 436-0700

2900 E 29th St
Ste 100
Bryan, TX 77802
Phone (979) 436-0485

2900 E 29th St
Ste 200
Bryan, TX 77802
Phone (979) 436-0483

Organizations & group practices 2

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": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1891157707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 E 29TH ST STE 100",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022623",
            "telephone_number": "979-776-8440",
            "fax_number": "877-601-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 E 29TH ST STE 200",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022623",
            "telephone_number": "979-776-8440",
            "fax_number": "877-607-5854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3107 8th Ave Apt 103",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761103820",
            "country_code": "US",
            "telephone_number": "469-585-4474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "MEREDITH",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-22",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37242",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TX",
            "license": "37242",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "TX",
            "license": "37242",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370439701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.