Healthcare Provider Details

I. General information

NPI: 1912575598
Provider Name (Legal Business Name): EMILY CLAIRE WILLS MMT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 STATE ROUTE 662 W
NEWBURGH IN
47630-1006
US

IV. Provider business mailing address

1820 ANTLER AVE
OWENSBORO KY
42303-1873
US

V. Phone/Fax

Practice location:
  • Phone: 812-490-9401
  • Fax:
Mailing address:
  • Phone: 270-316-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number14906
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: