Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 9496 | TX |
NPI | 1083717698 |
---|---|
Provider Name | Lee T Willis |
First Address | Houston, TX 77006-5015 |
Second Address | Houston, TX 77006-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 03/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
095412501 | (05) | TX |
82228L | BCBS (01) | TX |