Individual
ANGELA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 S 6TH ST, MURRAY, KY 42071-2516
(270) 807-0335
Mailing address
90 HOWARD DR, SHELBYVILLE, KY 40065-8138
(502) 633-1007
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
296413
KY
106S00000X
Behavior Technician
RBT-19-89190
KY
Other
Enumeration date
03/28/2019
Last updated
01/21/2025
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