Provider Demographics
NPI:1528257136
Name:WILLEY, SUSAN E
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:WILLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 MACINAW RD
Mailing Address - Street 2:2
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-3525
Mailing Address - Country:US
Mailing Address - Phone:530-541-5440
Mailing Address - Fax:530-541-0456
Practice Address - Street 1:921 MACINAW RD
Practice Address - Street 2:2
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3525
Practice Address - Country:US
Practice Address - Phone:530-541-5440
Practice Address - Fax:530-541-0456
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)