Provider Demographics
NPI:1477225241
Name:WILLIS, LINDA K (MS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 WELADAY CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8418
Mailing Address - Country:US
Mailing Address - Phone:901-338-9013
Mailing Address - Fax:
Practice Address - Street 1:6825 E HOLMES RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8505
Practice Address - Country:US
Practice Address - Phone:901-338-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health