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General NPI Number Information
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NPI Number | 1457821878
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Entity Type | Individual
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Provider Name | ZACHARY DYNELL WILLIS
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Gender | Male
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3580 WILSHIRE BLVD STE 2000
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City | LOS ANGELES
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State | CA
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Zip | 90010-2533
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Country | US
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Telephone | 213-381-1250
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Fax | 213-383-4803
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Provider Business Mailing Address
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Address Line | 1002 OSWEGO ST, UTICA
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City | UTICA
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State | NY
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Zip | 13502
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Country | US
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Telephone | 315-798-8868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State | NY
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