Provider Demographics
NPI:1518369669
Name:WILLETT, JOHN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:WILLETT
Suffix:
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 1:3356 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5905
Mailing Address - Country:US
Mailing Address - Phone:214-702-2576
Mailing Address - Fax:
Practice Address - Street 1:3356 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5905
Practice Address - Country:US
Practice Address - Phone:214-702-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional