Healthcare Provider Details

I. General information

NPI: 1083604235
Provider Name (Legal Business Name): TODD SPENCER WILLIS L.M.H.C., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALL ST
VALPARAISO IN
46383-2512
US

IV. Provider business mailing address

424B SEQUOIA DR
VALPARAISO IN
46385-8109
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-3500
  • Fax:
Mailing address:
  • Phone: 219-759-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001592A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000171100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: