Provider Demographics
NPI:1093178246
Name:WILLIS, HEATHER LEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:WILLIS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LIZZIE ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3062
Mailing Address - Country:US
Mailing Address - Phone:805-549-1200
Mailing Address - Fax:661-868-8834
Practice Address - Street 1:235 ATASCADERO RD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1516
Practice Address - Country:US
Practice Address - Phone:805-771-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW693381041C0700X
CALCSW1041861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical