MEDICARE: DR. REBECCA L WILLS PHD, LPC

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	37PC00322100	NJ
2	101YP2500X	Professional Counselor	PC012321	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	781952000	OTHER	NJ	MAGELLAN BEHAVIORAL MIS

General Provider Information

NPI Number	:	1487768255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA L WILLS PHD, LPC

Provider Business Mailing Address
First Line	:	608 E PHILADELPHIA AVE
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-2113
Country	:	US
Telephone Number	:	856-912-4038
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 E PHILADELPHIA AVE
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-2113
Country	:	US
Telephone Number	:	856-912-4038
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/03/2024

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