Healthcare Provider Details

I. General information

NPI: 1114795127
Provider Name (Legal Business Name): RAYMOND WILLIS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 61ST AVE SW
SEATTLE WA
98116-3028
US

IV. Provider business mailing address

3444 61ST AVE SW
SEATTLE WA
98116-3028
US

V. Phone/Fax

Practice location:
  • Phone: 206-225-1652
  • Fax:
Mailing address:
  • Phone: 206-225-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number402029C
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: