MEDICARE: MRS. STELLA INGRID WILLSON LCSW

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	1041C0700X	Clinical Social Worker	52462	TX

General Provider Information

NPI Number	:	1114217809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA INGRID WILLSON LCSW

Provider Business Mailing Address
First Line	:	7101 VIRGINIA PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5753
Country	:	US
Telephone Number	:	214-643-3411
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 VIRGINIA PKWY
Second Line	:	#843
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5753
Country	:	US
Telephone Number	:	214-643-3411
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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