Healthcare Provider Details

I. General information

NPI: 1578727616
Provider Name (Legal Business Name): CURTIS E WILLS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HIGHWAY 365 110
NEDERLAND TX
77627-6256
US

IV. Provider business mailing address

2300 HIGHWAY 365 110
NEDERLAND TX
77627-6256
US

V. Phone/Fax

Practice location:
  • Phone: 409-729-0400
  • Fax:
Mailing address:
  • Phone: 409-729-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21163
License Number StateTX

VIII. Authorized Official

Name: CURTIS E WILLS
Title or Position: OWNER
Credential: PHD
Phone: 409-729-0400