Basic Information
| Provider Information | |||||||||
| NPI: | 1144937905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEXTON | ||||||||
| FirstName: | WILLARD | ||||||||
| MiddleName: | LUTHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12070 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627777500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10425 PAINTER AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629062685 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2022 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.