Healthcare Provider Details

I. General information

NPI: 1689912248
Provider Name (Legal Business Name): KATHLEEN ANNE WILLS B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANNE WILLS B.A.

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 N MORRISON AVE
SAN JOSE CA
95126-2741
US

IV. Provider business mailing address

264 N MORRISON AVE
SAN JOSE CA
95126-2741
US

V. Phone/Fax

Practice location:
  • Phone: 805-890-9247
  • Fax:
Mailing address:
  • Phone: 805-890-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35969
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number94024326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: