MEDICARE: PROF. XAVIER DIRELL WILLIS M.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101200000X	Drama Therapist
2	221700000X	Art Therapist
3	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1144934852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. XAVIER DIRELL WILLIS M.A.

Provider Business Mailing Address
First Line	:	2867 MAYFIELD RD APT 1
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1633
Country	:	US
Telephone Number	:	216-645-8677
Fax Number	:

Provider Business Practice Location Address
First Line	:	2867 MAYFIELD RD APT 1
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1633
Country	:	US
Telephone Number	:	216-645-8677
Fax Number	:

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

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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