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NPI Code Detail

MEDICARE: BOBBI WILLIS

MEDICARE: BOBBI 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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1053640276
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBI WILLIS
Provider Business Mailing Address
First Line : 11116 HIGHWAY 60
Second Line :
City : SELLERSBURG
State : IN
Zip : 47172-9602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7509 CHARLESTOWN PIKE
Second Line :
City : CHARLESTOWN
State : IN
Zip : 47111-9623
Country : US
Telephone Number : 812-256-4686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2009
Last Update Date : 12/17/2009

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Directions to “ BOBBI WILLIS ” Practice Location

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