Provider Demographics
NPI:1902579428
Name:WILLIS-AREMO, AZIZA (TLLP)
Entity type:Individual
Prefix:
First Name:AZIZA
Middle Name:
Last Name:WILLIS-AREMO
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BETH AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-3630
Mailing Address - Country:US
Mailing Address - Phone:248-716-5135
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 1205
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3284
Practice Address - Country:US
Practice Address - Phone:248-716-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist