Provider Demographics
NPI:1548727118
Name:WILLIS, ELSA FRANCIS (LPC-7187)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:FRANCIS
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPC-7187
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E FRONT ST APT 420
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7316
Mailing Address - Country:US
Mailing Address - Phone:208-720-0469
Mailing Address - Fax:
Practice Address - Street 1:190 E FRONT ST APT 420
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7316
Practice Address - Country:US
Practice Address - Phone:208-720-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional