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NPI Code Detail

MEDICARE: TRISHA NICOLE WILLISON LPC CANDIDATE

MEDICARE: TRISHA NICOLE WILLISON LPC CANDIDATE
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1578380267
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISHA NICOLE WILLISON LPC CANDIDATE
Provider Business Mailing Address
First Line : 27421 E 108TH PL S
Second Line :
City : COWETA
State : OK
Zip : 74429-9013
Country : US
Telephone Number : 918-698-0451
Fax Number :
Provider Business Practice Location Address
First Line : 2448 E 81ST ST STE 4460
Second Line :
City : TULSA
State : OK
Zip : 74137-4251
Country : US
Telephone Number : 918-600-2966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2024
Last Update Date : 09/24/2024

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