Active NPI
Kwin Leslie Willis
- Marriage & Family Therapist
- Richmond, UT
National Provider Identifier
1881940302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 9578164-3902
- Practice address
- 44 N Highway 91 Ste 1
Richmond, UT 84333-1419 - Phone
- (435) 535-5784
- NPI assigned
- Aug 2, 2012
- Last updated
- Oct 23, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 9578164-3902 | UT | Primary |
Addresses
Primary practice location
44 N Highway 91 Ste 1
Richmond, UT 84333-1419
Mailing address
825 East 1090 South
Provo, UT 84606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 18, 2024 through Jul 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9578164-3902 | UT | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1881940302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 EAST 1090 SOUTH",
"city": "PROVO",
"state": "UT",
"postal_code": "84606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 N HIGHWAY 91 STE 1",
"city": "RICHMOND",
"state": "UT",
"postal_code": "843331419",
"telephone_number": "435-535-5784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "KWIN",
"middle_name": "LESLIE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-02",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "UT",
"license": "9578164-3902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.