Individual
DIANE JANICE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4520 RIDGELINE DR, NORMAN, OK 73072-1729
(405) 364-9091
Mailing address
4520 RIDGELINE DR, NORMAN, OK 73072-1729
(405) 364-9091
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
164
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1202405
—
OK
Enumeration date
03/07/2008
Last updated
03/07/2008
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