Provider Demographics
NPI:1447057179
Name:WILLIAMSON, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 CROSSPOINT BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3387
Mailing Address - Country:US
Mailing Address - Phone:462-205-0087
Mailing Address - Fax:462-205-0087
Practice Address - Street 1:10475 CROSSPOINT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3387
Practice Address - Country:US
Practice Address - Phone:462-205-0087
Practice Address - Fax:462-205-0087
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-25-415919106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician