Provider Demographics
NPI:1902926470
Name:WILLOUGHBY, JON T (MC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:T
Last Name:WILLOUGHBY
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8124 E CACTUS RD STE 410
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5262
Mailing Address - Country:US
Mailing Address - Phone:602-494-1515
Mailing Address - Fax:
Practice Address - Street 1:8124 E CACTUS RD STE 410
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5262
Practice Address - Country:US
Practice Address - Phone:602-494-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional