MEDICARE: WILLIS COUNSELING & CONSULTING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588478978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIS COUNSELING & CONSULTING

Provider Business Mailing Address
First Line	:	5834 MONROE ST STE 1201
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1947 RICHARDS RD APT 10
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1040
Country	:	US
Telephone Number	:	567-318-2586
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	KAJUAN WILLIS
Credential	:	LPC
Telephone Number	:	240-278-9213

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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