Provider Demographics
NPI:1073758892
Name:WILLETT, TROY DOUGLAS (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:DOUGLAS
Last Name:WILLETT
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W RAPP RD UNIT 94
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-8669
Mailing Address - Country:US
Mailing Address - Phone:541-727-1558
Mailing Address - Fax:
Practice Address - Street 1:310 OAK ST STE 2
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1877
Practice Address - Country:US
Practice Address - Phone:541-727-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60169232101YM0800X
OR101YP2500X
101YP2500X
ORC4750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health