Healthcare Provider Details

I. General information

NPI: 1053561472
Provider Name (Legal Business Name): PAULA JEAN WILLIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N BURL AVE
CLOVIS CA
93619-2865
US

IV. Provider business mailing address

1920 N BURL AVE
CLOVIS CA
93619-2865
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-2475
  • Fax: 559-325-1919
Mailing address:
  • Phone: 559-274-2475
  • Fax: 559-325-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: