Provider Demographics
NPI:1629445259
Name:WILLIS, ROBERT (BCBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WILLIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-8976
Mailing Address - Country:US
Mailing Address - Phone:925-980-9214
Mailing Address - Fax:
Practice Address - Street 1:6311 N 15TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-8976
Practice Address - Country:US
Practice Address - Phone:925-980-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst