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NPI Code Detail

MEDICARE: FEHRUNISSA M WILLETT LPCC

MEDICARE:   FEHRUNISSA M WILLETT  LPCC
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
1101Y00000XCounselor0093361NM

General Provider Information

NPI Number : 1669673083
Entity Type Code : Individual
Provider Name (Legal Business Name) : FEHRUNISSA M WILLETT LPCC
Provider Business Mailing Address
First Line : 2 CABEZON RD
Second Line :
City : PLACITAS
State : NM
Zip : 87043-9200
Country : US
Telephone Number : 505-268-1903
Fax Number :
Provider Business Practice Location Address
First Line : 1717 LOUISIANA BLVD NE
Second Line : SUITE 102
City : ALBUQUERQUE
State : NM
Zip : 87110-7001
Country : US
Telephone Number : 505-268-1903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2007
Last Update Date : 07/08/2007

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Directions to “ FEHRUNISSA M WILLETT LPCC” Practice Location

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