Provider Demographics
NPI:1467103010
Name:WILLA JEAN GROUP LLC
Entity Type:Organization
Organization Name:WILLA JEAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TWYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER-SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-482-8791
Mailing Address - Street 1:3961 E CHANDLER BLVD 111-234
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0303
Mailing Address - Country:US
Mailing Address - Phone:480-482-8791
Mailing Address - Fax:
Practice Address - Street 1:3961 E CHANDLER BLVD
Practice Address - Street 2:111-234
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0303
Practice Address - Country:US
Practice Address - Phone:480-482-8791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health