Provider Demographics
NPI:1255455036
Name:WILLIS, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 CAVANESS AVE
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1411
Mailing Address - Country:US
Mailing Address - Phone:928-684-6616
Mailing Address - Fax:
Practice Address - Street 1:920 S. VULTURE MINE ROAD
Practice Address - Street 2:SPECIAL SERVICES DEPT.
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390
Practice Address - Country:US
Practice Address - Phone:928-684-6714
Practice Address - Fax:928-684-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool