MEDICARE: MRS. PATRICE ROZELL WILLS MS, 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	18198	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790093581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICE ROZELL WILLS MS, LPC

Provider Business Mailing Address
First Line	:	2424 AUSTIN AVE STE 204
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1511
Country	:	US
Telephone Number	:	254-744-1412
Fax Number	:	254-732-7180

Provider Business Practice Location Address
First Line	:	2424 AUSTIN AVE STE 204
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1511
Country	:	US
Telephone Number	:	254-744-1412
Fax Number	:	254-732-7180

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

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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