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THEODORE JIM WILLIS III
NPI 1104506856
Behavior Analyst in Stockton, CA

Active since July 18, 2023
1811 GRAND CANAL BLVD STE 2, STOCKTON, CA 95207(888) 880-9270 Get Directions Write a Review

NPPES record last updated: July 18, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Theodore Jim Willis Iii NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THEODORE JIM WILLIS III (NPI 1104506856) is an individual behavior analyst provider in Stockton, California and active in the NPI registry since July 2023.

NPPES Registry Identity

NPI1104506856
Entity TypeIndividualMale
Primary Taxonomy103K00000X
Provider Legal NameTHEODORE JIM WILLIS III
Location Address1811 GRAND CANAL BLVD STE 2Stockton, CA 95207-8107
Mailing Address350 Fairway Dr Ste 101Deerfield Beach, FL 33441-1834 · (877) 418-2978 · Fax (866) 500-2186
Phone(888) 880-9270
Sole ProprietorNo
Enumeration DateJuly 18, 2023
NPPES CertifiedJuly 18, 2023
✔ NPI 1104506856 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyBehavior AnalystBehavioral Health & Social Service Providers
Taxonomy Code103K00000X
Definition
A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.
1811 GRAND CANAL BLVD STE 2, Stockton, CA 95207
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHADEED HASAN II
Behavior Analyst
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (877) 418-2978
JAYNEE YANG
Behavior Technician
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (916) 683-1109
TIFFANY TOWLE
Behavior Technician
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (209) 942-1155
BRIANA GUZMAN
Behavior Technician
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (877) 418-2978
ELISE ROSE ESCOBAR
Behavior Analyst
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (877) 418-2978
SALLY SOROUR
Behavior Technician
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (888) 880-9270
HECTOR ARVIZU-MEDINA
Behavior Technician
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (209) 452-8996
ALYSSA MANDY ITURRIAGA
Behavior Technician
1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207
San Joaquin County (209) 452-8996

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Willis's NPI number?

The NPI number for Theodore Willis is 1104506856. It was assigned to this individual provider in the NPPES registry on July 18, 2023.

Where is Theodore Willis located?

Theodore Willis practices at 1811 Grand Canal Blvd Ste 2, Stockton, CA 95207. The listed phone number is (888) 880-9270.

What is Theodore Willis's specialty?

The primary specialty registered for this NPI is Behavior Analyst with taxonomy code 103K00000X.

When was this NPI record last updated?

The NPPES record for Theodore Willis was last updated on July 18, 2023, 3 years ago. NPI Profile syncs with the weekly NPPES data releases published by CMS; the most recent full sync was completed on July 26, 2026. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.