Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 64641 | CA |
N | 225400000X | Rehabilitation Practitioner | 64641 | CA |
NPI | 1013227255 |
---|---|
Provider Name | Mrs. Elsa Yolanda Willard |
First Address | Glendora, CA 91740-5000 |
Second Address | Glendora, CA 91740-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 22/11/2017 |