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General NPI Number Information
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NPI Number | 1972959237
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Entity Type | Individual
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Provider Name | DAVID M WILLIS LPC
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Gender | Male
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 7846 HIGHBROOK DR
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City | MAINEVILLE
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State | OH
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Zip | 45039-7327
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Country | US
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Telephone | 970-690-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 212 COOK RD
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City | LEBANON
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State | OH
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Zip | 45036-9600
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Country | US
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Telephone | 513-896-7887
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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 | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2002768
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License Number State | OH
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