Provider Demographics
NPI:1114795127
Name:WILLIS, RAYMOND (MS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 61ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3028
Mailing Address - Country:US
Mailing Address - Phone:206-225-1652
Mailing Address - Fax:
Practice Address - Street 1:3444 61ST AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3028
Practice Address - Country:US
Practice Address - Phone:206-225-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA402029C101YS0200X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool