Active NPI
Diane Janice Willis, PHD
- Clinical Child & Adolescent Psychologist
- Norman, OK
National Provider Identifier
1306016118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 164
- Practice address
- 4520 Ridgeline Dr
Norman, OK 73072-1729 - Phone
- (405) 364-9091
- NPI assigned
- Mar 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 164 | OK | Primary |
Addresses
Primary practice location
4520 Ridgeline Dr
Norman, OK 73072-1729
Mailing address
4520 Ridgeline Dr
Norman, OK 73072-1729
Phone (405) 364-9091
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1202405 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164 | OK | MD | Genetic Counselor (M.S.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204848000000",
"number": "1306016118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4520 RIDGELINE DR",
"city": "NORMAN",
"state": "OK",
"postal_code": "730721729",
"telephone_number": "405-364-9091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4520 RIDGELINE DR",
"city": "NORMAN",
"state": "OK",
"postal_code": "730721729",
"telephone_number": "405-364-9091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "DIANE",
"middle_name": "JANICE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-07",
"last_updated": "2008-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OK",
"license": "164",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1202405",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norman, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.