Provider Demographics
NPI:1184190324
Name:WILLIS, CHAD RILEY JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:RILEY
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N CENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6733
Mailing Address - Country:US
Mailing Address - Phone:480-527-0337
Mailing Address - Fax:480-452-1311
Practice Address - Street 1:303 N CENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6733
Practice Address - Country:US
Practice Address - Phone:480-527-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional