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General NPI Number Information
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NPI Number | 1629185327
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Entity Type | Individual
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Provider Name | STEVEN JERROLD WILLIS MED
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1111 12TH STREET SUITE 204
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City | KEY WEST
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State | FL
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Zip | 33040-3011
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Country | US
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Telephone | 305-747-2124
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Fax | 305-293-4339
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Provider Business Mailing Address
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Address Line | 1111 12TH STREET SUITE 204
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City | KEY WEST
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State | FL
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Zip | 33040-3011
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Country | US
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Telephone | 305-747-2124
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Fax | 305-293-4339
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MHC 6306
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT 2056
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License Number State | FL
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