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NPI Code Detail

MEDICARE: CHANSEY LARON WILLIS

MEDICARE: CHANSEY LARON WILLIS
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
1106S00000XBehavior TechnicianMI

General Provider Information

NPI Number : 1437045226
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANSEY LARON WILLIS
Provider Business Mailing Address
First Line : 20700 CIVIC CENTER DR STE 110
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48076-4102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20700 CIVIC CENTER DR STE 110
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48076-4102
Country : US
Telephone Number : 800-385-1035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2025
Last Update Date : 12/18/2025

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Directions to “ CHANSEY LARON WILLIS ” Practice Location

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