Provider Demographics
NPI:1811351208
Name:WILLIS, SAGE (PHD)
Entity type:Individual
Prefix:DR
First Name:SAGE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 D ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3204
Mailing Address - Country:US
Mailing Address - Phone:360-935-0860
Mailing Address - Fax:360-935-0870
Practice Address - Street 1:2003 D ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3204
Practice Address - Country:US
Practice Address - Phone:360-935-0860
Practice Address - Fax:360-935-0870
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60692403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical