Healthcare Provider Details

I. General information

NPI: 1598672255
Provider Name (Legal Business Name): MCARTHUR SHELTON WILLIS IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 S MARTIN LUTHER KING BLVD
FRESNO CA
93706
US

IV. Provider business mailing address

475 N MANILA AVE APT 209
FRESNO CA
93727-3428
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: