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NPI Code Detail

MEDICARE: ANGEL WILLIS

MEDICARE: ANGEL WILLIS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1013761642
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGEL WILLIS
Provider Business Mailing Address
First Line : 6611 RIVER PLACE BLVD STE 105
Second Line :
City : AUSTIN
State : TX
Zip : 78730-1176
Country : US
Telephone Number : 855-444-5664
Fax Number :
Provider Business Practice Location Address
First Line : 6611 RIVER PLACE BLVD STE 105
Second Line :
City : AUSTIN
State : TX
Zip : 78730-1176
Country : US
Telephone Number : 855-444-5664
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2024
Last Update Date : 04/11/2024

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Directions to “ ANGEL WILLIS ” Practice Location

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