Provider Demographics
NPI:1619087418
Name:WILLSON, FRANCES ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:ELIZABETH
Last Name:WILLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 BALBOA BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1585
Mailing Address - Country:US
Mailing Address - Phone:661-222-7199
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:209
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-990-0221
Practice Address - Fax:661-222-7902
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY1106Z103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY1106ZMedicare ID - Type Unspecified