MEDICARE: MRS. CINDY L WILLIS 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	4108	LA

General Provider Information

NPI Number	:	1720423593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CINDY L WILLIS LPC

Provider Business Mailing Address
First Line	:	236 CATTAIL TRL
Second Line	:
City	:	BENTON
State	:	LA
Zip	:	71006-9719
Country	:	US
Telephone Number	:	318-510-0612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 KNIGHT ST STE 112
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105
Country	:	US
Telephone Number	:	318-510-0612
Fax Number	:

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

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	07/13/2018

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