Healthcare Provider Details

I. General information

NPI: 1336265925
Provider Name (Legal Business Name): WILHELMINA CALIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12775 E MARY ANN CLEVELAND WAY
VAIL AZ
85641-8600
US

IV. Provider business mailing address

7550 S PLACITA DE CERVECAS
TUCSON AZ
85747-9621
US

V. Phone/Fax

Practice location:
  • Phone: 520-879-2815
  • Fax: 520-879-1856
Mailing address:
  • Phone: 520-647-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: