Basic Information
| Provider Information | |||||||||
| NPI: | 1255428041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2908 SCHATTIG LN | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982777815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606751232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982734209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604193500 | ||||||||
| FaxNumber: | 3604193505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00036980 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.