Provider Demographics
NPI:1083717698
Name:WILLIS, LEE T (MA LPC RN)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:T
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MA LPC RN
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:T
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC RN
Mailing Address - Street 1:401 BRANARD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5015
Mailing Address - Country:US
Mailing Address - Phone:713-529-0037
Mailing Address - Fax:713-526-4367
Practice Address - Street 1:401 BRANARD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5015
Practice Address - Country:US
Practice Address - Phone:713-529-0037
Practice Address - Fax:713-526-4367
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9496101YP1600X
TX421862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82228LOtherBCBS
TX095412501Medicaid