Provider Demographics
NPI:1639773583
Name:WILLIS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WILLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 CITRUS CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2667
Mailing Address - Country:US
Mailing Address - Phone:925-256-1100
Mailing Address - Fax:925-256-1100
Practice Address - Street 1:3075 CITRUS CIR STE 240
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2667
Practice Address - Country:US
Practice Address - Phone:925-256-1100
Practice Address - Fax:925-256-1100
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty