Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1013256239 |
---|---|
Provider Name | Kristin Leann Willis |
First Address | Tuttle, OK 73089-3138 |
Second Address | Tuttle, OK 73089-3138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2013 |
Last Update Date | 07/02/2013 |