MEDICARE: ANNE K WILLE MS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	PPC-669	WY
2	101YM0800X	Mental Health Counselor	C.2103854	OH
3	101YP2500X	Professional Counselor	LPC - 1449	WY
4	101Y00000X	Counselor	LPC-1449	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	134420000	OTHER	WY	WY STATE PROVIDER #

General Provider Information

NPI Number	:	1306181573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE K WILLE MS LPC

Provider Business Mailing Address
First Line	:	180 WHITE BARN PKWY
Second Line	:
City	:	OSTRANDER
State	:	OH
Zip	:	43061-9010
Country	:	US
Telephone Number	:	219-928-3613
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 WHITE BARN PKWY
Second Line	:
City	:	OSTRANDER
State	:	OH
Zip	:	43061-9010
Country	:	US
Telephone Number	:	219-928-3613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	12/08/2021

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