Provider Demographics
NPI:1437032653
Name:WILLIS, ADDISON PARKER (LMHCA)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:PARKER
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1459
Mailing Address - Country:US
Mailing Address - Phone:972-765-8388
Mailing Address - Fax:
Practice Address - Street 1:90 W ASH ST
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1459
Practice Address - Country:US
Practice Address - Phone:972-765-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99130753A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health