1619606589 NPI number — JAMES F WILLIS LPC

Table of content: JAMES F WILLIS LPC (NPI 1619606589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619606589 NPI number — JAMES F WILLIS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIS
Provider First Name:
JAMES
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619606589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-1241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-648-7334
Provider Business Mailing Address Fax Number:
251-405-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1156 SPRING HILL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-648-7334
Provider Business Practice Location Address Fax Number:
251-405-3323
Provider Enumeration Date:
06/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3764 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 257843 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com