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General NPI Number Information
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NPI Number | 1811351208
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Entity Type | Individual
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Provider Name | SAGE WILLIS PHD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 2003 D ST STE 100
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City | BELLINGHAM
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State | WA
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Zip | 98225-3204
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Country | US
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Telephone | 360-935-0860
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Fax | 360-935-0870
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Provider Business Mailing Address
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Address Line | 2003 D ST STE 100
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City | BELLINGHAM
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State | WA
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Zip | 98225-3204
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Country | US
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Telephone | 360-935-0860
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Fax | 360-935-0870
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 60692403
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License Number State | WA
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