=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881060986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADRIAN WILLEY PH.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2015
-----------------------------------------------------
Last Update Date | 08/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3223 LAKESHORE AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94610-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-485-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3223 LAKESHORE AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94610-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-485-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ADRIAN LLOYD WILLEY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 510-485-1988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PSY27079
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------