Organization
MINDBODY WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY L. WILLIS-CENTER PH.D. (CLINICAL PSYCHOLOGIST)
(417) 440-0826
Entity
Organization
Contact information
Practice address
1407 S ELLIOTT AVE, SUITE B, AURORA, MO 65605-2103
(417) 440-0826
Mailing address
1407 S ELLIOTT AVE, SUITE B, AURORA, MO 65605-2103
(417) 440-0826
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2008007986
MO
Other
Enumeration date
05/02/2008
Last updated
05/02/2008
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