Provider Demographics
NPI:1235113499
Name:WILLETT, RODNA SUE (LPC)
Entity Type:Individual
Prefix:MS
First Name:RODNA
Middle Name:SUE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S HIGHWAY 347
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4204
Mailing Address - Country:US
Mailing Address - Phone:409-727-5433
Mailing Address - Fax:877-376-2409
Practice Address - Street 1:520 S HIGHWAY 347
Practice Address - Street 2:SUITE 106
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4204
Practice Address - Country:US
Practice Address - Phone:409-727-5433
Practice Address - Fax:877-376-2409
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3840LCOtherBCBS OF TX
TX2009424OtherCIGNA