Provider Demographics
NPI:1013467281
Name:WILLIS, HEATHER LYNETTE
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:LYNETTE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7407
Mailing Address - Country:US
Mailing Address - Phone:405-848-7555
Mailing Address - Fax:405-949-0929
Practice Address - Street 1:2808 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7407
Practice Address - Country:US
Practice Address - Phone:405-848-7555
Practice Address - Fax:405-949-0929
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor