MEDICARE: DR. RICHARD G. WILLIS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY3774	FL
2	103TC0700X	Clinical Psychologist	0810002852	VA

General Provider Information

NPI Number	:	1568677748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD G. WILLIS PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 2495
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24402-2495
Country	:	US
Telephone Number	:	540-255-1354
Fax Number	:	540-213-0620

Provider Business Practice Location Address
First Line	:	1301 RICHMOND AVE
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-9146
Country	:	US
Telephone Number	:	540-255-1354
Fax Number	:	540-213-0620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	03/22/2026

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