Individual
PATRICIA WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
541 N LEWIS, MESA, AZ 85201-5910
(480) 593-3803
Mailing address
541 N LEWIS, MESA, AZ 85201-5910
(480) 593-3803
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
9482
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
916182
AHCCCS ID NUMBER
AZ
Enumeration date
11/21/2006
Last updated
07/08/2007
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