Willis, Kathy Renee

Willis, Kathy Renee is an sole proprietor health care provider with primary practice located at 11026 E Segura Ave , Mesa AZ 85212-5214. She recently has 2 registered licenses in different health care specialties including Respite Care Facility / Respite Care, Mental Illness, Child, Behavioral Health & Social Service Providers / Social Worker. Respite Care Facility / Respite Care, Mental Illness, Child is her primary health care specialty. Willis, Kathy Renee can be contacted via phone (480) 235-9107.

Contact Information

Primary practice address
11026 E Segura Ave Mesa AZ 85212-5214
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Respite Care Facility / Respite Care, Mental Illness, Child 385HR2055X 3162012 Arizona
Behavioral Health & Social Service Providers / Social Worker 104100000X 3162012 Arizona

Profile Details

NPI number 1932476611
LBN Legal business name Willis, Kathy Renee
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 22nd, 2011
Last updated Aug 17th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932476611 NPPES
Arizona Other 3162012 AZ DEPT OF HEALTH SERVICES

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