Shirley Anne Willis, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

21860 Issued in TX

Practice address

2340 W Interstate 20
BLDG. HR-II, Ste. 206
Arlington, TX 76017-7620

Phone

(814) 466-2585

Fax

(817) 466-2596

NPI assigned

Nov 28, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Texas Tech University Health Science Center School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Texas Developmental Pediatric & Behavorial Health Network, P.a.

  • Counselor
  • Lubbock, TX
  • NPI 1588774541
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1023184264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 W INTERSTATE 20",
            "address_2": "BLDG. HR-II, STE. 206",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760177620",
            "telephone_number": "814-466-2585",
            "fax_number": "817-466-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 W INTERSTATE 20",
            "address_2": "BLDG. HR-II, STE. 206",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760177620",
            "telephone_number": "814-466-2585",
            "fax_number": "817-466-2596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHIRLEY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "21860",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096833101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00H45R",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracey M Williams, LPC
• Zandera Williams, LPC
• Crystal J. Williamson, MS, LCSW
• Willis Counseling Services, LLC
• Gary Glen Willis, OD
• Susan M. Willis, CRNA
• Tamara Lynn Willmoth, PA-C
• Ambrosia Willoughby, PA-C
• Bethany Willoughby, SLP- INTERN
• Wilnick Surgical Supply

• Psychologist in Arlington, TX
• Providers in Arlington, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.