Healthcare Provider Details

I. General information

NPI: 1922746759
Provider Name (Legal Business Name): HALEY MARIE WILLS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 E ADAMS ST
JACKSON MO
63755-2150
US

IV. Provider business mailing address

614 E ADAMS ST
JACKSON MO
63755-2150
US

V. Phone/Fax

Practice location:
  • Phone: 573-243-9527
  • Fax: 573-243-9525
Mailing address:
  • Phone: 573-243-9527
  • Fax: 573-243-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025016362
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2025016362
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: