Provider Demographics
NPI:1770750614
Name:WILLISON, MARK P (MFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:WILLISON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CAMINO AGUAJITO STE 205
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3372
Mailing Address - Country:US
Mailing Address - Phone:831-277-9999
Mailing Address - Fax:831-272-2396
Practice Address - Street 1:200 CAMINO AGUAJITO STE 205
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3372
Practice Address - Country:US
Practice Address - Phone:831-277-9999
Practice Address - Fax:831-272-2396
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health