MEDICARE: DEANN MARIE WILLS LPC, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	83070	TX

General Provider Information

NPI Number	:	1013589878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANN MARIE WILLS LPC, LCDC

Provider Business Mailing Address
First Line	:	2054 NALL ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-3714
Country	:	US
Telephone Number	:	409-540-2055
Fax Number	:

Provider Business Practice Location Address
First Line	:	2054 NALL ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-3714
Country	:	US
Telephone Number	:	406-540-2055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/15/2021

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