Provider Demographics
NPI:1649345240
Name:WILLETT, TONYA SUE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:SUE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:SUE
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:151 W. DANA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444
Mailing Address - Country:US
Mailing Address - Phone:805-459-5028
Mailing Address - Fax:805-723-5035
Practice Address - Street 1:151 W. DANA ST STE 201
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444
Practice Address - Country:US
Practice Address - Phone:805-459-5028
Practice Address - Fax:805-723-5035
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist