MEDICARE: BARRY WILLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDPT.CO.70033973	WA

General Provider Information

NPI Number	:	1043174881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY WILLIS

Provider Business Mailing Address
First Line	:	1412 SW 43RD ST STE 140
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-4803
Country	:	US
Telephone Number	:	425-264-0750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 SW 43RD ST STE 140
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-4803
Country	:	US
Telephone Number	:	425-264-0750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ BARRY WILLIS ” Practice Location

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