Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miss. Kathy Renee Willis

Individual provider Child Mental Illness Respite Care · NPI 1932476611

Miss. Kathy Renee Willis is a Child Mental Illness Respite Care in Mesa, Arizona. Practices as a sole proprietor and works from 2 locations. Licensed in Arizona.

Licensed in
AZ
In the registry since
2011
Specialties on file
2

Practice location Address checks out

11026 E Segura Ave
Mesa, AZ 85212-5214
Phone: (480) 235-9107
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2320 W Peoria Ave Ste C111, Phoenix, AZ 85029-4715 — (602) 283-7100

Specialties & licences

Child Mental Illness Respite Care (primary) Taxonomy 385HR2055X · Licence 3162012 (AZ)
Social Worker Taxonomy 104100000X · Licence 3162012 (AZ)

Record details

NPI number1932476611
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 22, 2011
Last updated in NPPESAugust 17, 2020
Certification dateAugust 17, 2020

Other providers in Mesa