Healthcare Provider Details

I. General information

NPI: 1801535265
Provider Name (Legal Business Name): JOHN PAUL WILLIS CIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 EARHART BLVD
NEW ORLEANS LA
70125-1955
US

IV. Provider business mailing address

4150 EARHART BLVD
NEW ORLEANS LA
70125-1955
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-7120
  • Fax:
Mailing address:
  • Phone: 504-821-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCIT-6105
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberOBHPSS883
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: