Provider Demographics
NPI:1144874033
Name:WILLETT COUNSELING, LLC
Entity type:Organization
Organization Name:WILLETT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-623-4004
Mailing Address - Street 1:5019 KAIN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4333
Mailing Address - Country:US
Mailing Address - Phone:314-623-4004
Mailing Address - Fax:
Practice Address - Street 1:8780 BIG BEND BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3774
Practice Address - Country:US
Practice Address - Phone:314-623-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty