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General NPI Number Information
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NPI Number | 1043765290
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Entity Type | Individual
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Provider Name | ANDREL M WILLIS PHD, LE, LMT, CHT
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Gender | Female
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 362 WILSHIRE ST
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City | PARK FOREST
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State | IL
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Zip | 60466-1514
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Country | US
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Telephone | 815-790-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 362 WILSHIRE ST
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City | PARK FOREST
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State | IL
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Zip | 60466-1514
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Country | US
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Telephone | 815-790-0899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227017963
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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