MEDICARE: WILLIS ULYSSES ALEXANDER JR.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619239720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIS ULYSSES ALEXANDER JR.

Provider Business Mailing Address
First Line	:	1408 NE 5TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-2406
Country	:	US
Telephone Number	:	405-659-6405
Fax Number	:

Provider Business Practice Location Address
First Line	:	5929 N MAY AVE STE 218
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3925
Country	:	US
Telephone Number	:	405-254-5040
Fax Number	:

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

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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