MEDICARE: MS. TRICIA WILLS LSW

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	S200083	OH

General Provider Information

NPI Number	:	1750829719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRICIA WILLS LSW

Provider Business Mailing Address
First Line	:	665 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3245
Country	:	US
Telephone Number	:	614-579-7067
Fax Number	:	614-652-4311

Provider Business Practice Location Address
First Line	:	665 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3245
Country	:	US
Telephone Number	:	614-579-7067
Fax Number	:	614-652-4311

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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